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General NPI Number Information
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NPI Number | 1457135881
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Entity Type | Individual
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Provider Name | DR. MARISA CARGILL
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Gender | Female
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 3443 MEDINA RD STE 101C
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City | MEDINA
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State | OH
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Zip | 44256-5965
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Country | US
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Telephone | 216-285-0304
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Fax |
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Provider Business Mailing Address
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Address Line | 674 LILAC LN
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City | COPLEY
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State | OH
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Zip | 44321-2896
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Country | US
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Telephone | 330-715-2141
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.2202900-SUPV
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License Number State | OH
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