Healthcare Provider Details

I. General information

NPI: 1386551646
Provider Name (Legal Business Name): TINA XIONG GONZALEZ LICENSED CLINICAL SOCIAL WORKER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7897 KELVEDON WAY
SACRAMENTO CA
95829-1452
US

IV. Provider business mailing address

5960 S LAND PARK DR # 1063
SACRAMENTO CA
95822-3313
US

V. Phone/Fax

Practice location:
  • Phone: 209-294-0036
  • Fax:
Mailing address:
  • Phone: 209-294-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. TINA XIONG GONZALEZ
Title or Position: PRESIDENT
Credential: LCSW
Phone: 209-294-0036