Provider Demographics
NPI:1295283398
Name:CARGILL, SHONTEL (LMFT)
Entity type:Individual
Prefix:
First Name:SHONTEL
Middle Name:
Last Name:CARGILL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHONTEL
Other - Middle Name:
Other - Last Name:SOLOMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:3146 CLEFTSTONE TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-9404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3146 CLEFTSTONE TRL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-9404
Practice Address - Country:US
Practice Address - Phone:912-288-4817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000351106H00000X
GAMFT001510106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist