Provider Demographics
NPI:1184237778
Name:GONZALEZ ECHEVARRIA, ANGELICA MARGARITA (PHD, LCSW, MSS)
Entity type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:MARGARITA
Last Name:GONZALEZ ECHEVARRIA
Suffix:
Gender:F
Credentials:PHD, LCSW, MSS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6600 VAN AALST BLVD BLDG 9250
Mailing Address - Street 2:
Mailing Address - City:FORT MOORE
Mailing Address - State:GA
Mailing Address - Zip Code:31905-2102
Mailing Address - Country:US
Mailing Address - Phone:762-408-4063
Mailing Address - Fax:
Practice Address - Street 1:MARTIN ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:6600 VAN AALST BLVD, BLDG 9250 FT MOORE
Practice Address - City:FT. MOORE
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:762-408-4063
Practice Address - Fax:762-408-1484
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR100111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical