Healthcare Provider Details

I. General information

NPI: 1649180811
Provider Name (Legal Business Name): ROXANNE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 S ROAN ST STE 105
JOHNSON CITY TN
37601-7679
US

IV. Provider business mailing address

2700 S ROAN ST STE 105
JOHNSON CITY TN
37601-7679
US

V. Phone/Fax

Practice location:
  • Phone: 423-631-0210
  • Fax: 423-631-0211
Mailing address:
  • Phone: 423-631-0210
  • Fax: 423-631-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9014
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: