Healthcare Provider Details

I. General information

NPI: 1093663841
Provider Name (Legal Business Name): ALYSSA GONZALEZ LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HAMILL RD STE 222C
BALTIMORE MD
21210-1815
US

IV. Provider business mailing address

1138 SPARROW MILL WAY
BEL AIR MD
21015-6134
US

V. Phone/Fax

Practice location:
  • Phone: 443-589-2475
  • Fax:
Mailing address:
  • Phone: 443-589-2475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC17054
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: