Provider Demographics
NPI:1700575719
Name:MONETTE, NEIL WAGGONER (PHD, NCC)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:WAGGONER
Last Name:MONETTE
Suffix:
Gender:M
Credentials:PHD, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 BRANDON TRL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8457
Mailing Address - Country:US
Mailing Address - Phone:404-997-2127
Mailing Address - Fax:
Practice Address - Street 1:2150 BRANDON TRL
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-8457
Practice Address - Country:US
Practice Address - Phone:404-997-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700575719OtherNPI #