=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023715414
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIN GONITZKE LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2023
-----------------------------------------------------
Last Update Date | 02/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 LOOP RD STE 8
-----------------------------------------------------
City | ARDEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28704-9224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-367-7716
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 LOOP RD STE 8
-----------------------------------------------------
City | ARDEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28704-9224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-367-7716
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 01504
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------