Healthcare Provider Details

I. General information

NPI: 1700261237
Provider Name (Legal Business Name): NELITZA DELISSE GONZALEZ LMFT, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 REYNOLDA RD
WINSTON SALEM NC
27104-3245
US

IV. Provider business mailing address

3708 SIGNET DR
WINSTON SALEM NC
27101-2254
US

V. Phone/Fax

Practice location:
  • Phone: 336-705-4018
  • Fax:
Mailing address:
  • Phone: 336-254-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11643
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1861
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: