Provider Demographics
NPI:1174875504
Name:VANDERSAND, LORENA GONZALEZ (PHD)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:GONZALEZ
Last Name:VANDERSAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LORENA
Other - Middle Name:LISA
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:150 PROVIDENCE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2208
Mailing Address - Country:US
Mailing Address - Phone:919-391-8284
Mailing Address - Fax:
Practice Address - Street 1:150 PROVIDENCE RD STE 101
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2208
Practice Address - Country:US
Practice Address - Phone:919-391-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4041103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling