Healthcare Provider Details

I. General information

NPI: 1477695732
Provider Name (Legal Business Name): ANITA GONZALEZ L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19020 CAPEHART DR
MONTGOMERY VILLAGE MD
20886-3935
US

IV. Provider business mailing address

19020 CAPEHART DR
MONTGOMERY VILLAGE MD
20886-3935
US

V. Phone/Fax

Practice location:
  • Phone: 301-691-8440
  • Fax: 240-780-3257
Mailing address:
  • Phone: 301-691-8440
  • Fax: 240-780-3257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC1576
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: