Provider Demographics
NPI:1821565433
Name:MONCAYO GILSTRAP, MARIA CRISTINA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CRISTINA
Last Name:MONCAYO GILSTRAP
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 1:80 OLD TENNESSEE RD NE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-5132
Mailing Address - Country:US
Mailing Address - Phone:404-590-6947
Mailing Address - Fax:
Practice Address - Street 1:650 HENDERSON DR STE 406
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3758
Practice Address - Country:US
Practice Address - Phone:770-334-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1249101YA0400X
GA013681101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)