Provider Demographics
NPI:1730244104
Name:MOFFET, MONICA (LCPC)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:
Last Name:MOFFET
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:MOFFET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:200 W. 3RD STREET
Mailing Address - Street 2:SUITE 707
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-7304
Mailing Address - Country:US
Mailing Address - Phone:618-463-5927
Mailing Address - Fax:618-463-5965
Practice Address - Street 1:3390 FOSTERBURG RD
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-7304
Practice Address - Country:US
Practice Address - Phone:618-462-4689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILLCPC 180-001642101YM0800X
IL180-001642LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health