Healthcare Provider Details

I. General information

NPI: 1821565433
Provider Name (Legal Business Name): MARIA CRISTINA MONCAYO GILSTRAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 05/13/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HENDERSON DR STE 406
CARTERSVILLE GA
30120-3758
US

IV. Provider business mailing address

80 OLD TENNESSEE RD NE
CARTERSVILLE GA
30121-5132
US

V. Phone/Fax

Practice location:
  • Phone: 770-334-2493
  • Fax:
Mailing address:
  • Phone: 404-590-6947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1249
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number013681
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC013681
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: