Healthcare Provider Details

I. General information

NPI: 1396558490
Provider Name (Legal Business Name): MAIGAN DANISHKA MONSANTO CRUZ LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 UNIONVILLE INDIAN TRAIL RD W # 100
INDIAN TRAIL NC
28079-5665
US

IV. Provider business mailing address

4685 HACKBERRY GROVE CIR APT 1836
CHARLOTTE NC
28269-2434
US

V. Phone/Fax

Practice location:
  • Phone: 704-438-9901
  • Fax:
Mailing address:
  • Phone: 929-204-6983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP021611
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: