Healthcare Provider Details

I. General information

NPI: 1629997820
Provider Name (Legal Business Name): DESTINY MARIE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W LANDIS AVE STE A-2
VINELAND NJ
08360-8133
US

IV. Provider business mailing address

421 FULTON ST
MILLVILLE NJ
08332-4309
US

V. Phone/Fax

Practice location:
  • Phone: 856-772-5809
  • Fax:
Mailing address:
  • Phone: 856-982-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: