Individual
CHILLIQUA SHONTA MANIGAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1601 SW ARCHER RD, GAINESVILLE, FL 32608-1135
(352) 548-6000
Mailing address
3724 NW 24TH BLVD APT 203, GAINESVILLE, FL 32605-5661
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW19219
FL
Other
Enumeration date
12/10/2021
Last updated
12/10/2021
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