Provider Demographics
NPI:1497365456
Name:ROLLE- CARGILL, DARLENE DENISE
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:DENISE
Last Name:ROLLE- CARGILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 INTEGRA DR APT 420
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-2592
Mailing Address - Country:US
Mailing Address - Phone:954-298-6394
Mailing Address - Fax:
Practice Address - Street 1:14050 INTEGRA DR APT 420
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2592
Practice Address - Country:US
Practice Address - Phone:954-298-6394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW136781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical