Provider Demographics
NPI:1487960498
Name:GONZALEZ, STEPHANIE D (LCSWA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 IVEY CHASE LN
Mailing Address - Street 2:#616
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3340
Mailing Address - Country:US
Mailing Address - Phone:917-331-2209
Mailing Address - Fax:
Practice Address - Street 1:10120 IVEY CHASE LN
Practice Address - Street 2:#616
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3340
Practice Address - Country:US
Practice Address - Phone:917-331-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor