Provider Demographics
NPI:1679380836
Name:CHARLESTON, MONICA LYNN (QMHPA)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNN
Last Name:CHARLESTON
Suffix:
Gender:F
Credentials:QMHPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10360 SW 186TH ST # 2204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33197-5001
Mailing Address - Country:US
Mailing Address - Phone:202-993-1475
Mailing Address - Fax:
Practice Address - Street 1:1211 S INDEPENDENCE DR APT D
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33034-2620
Practice Address - Country:US
Practice Address - Phone:202-993-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
No171400000XOther Service ProvidersHealth & Wellness Coach