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General NPI Number Information
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NPI Number | 1215475934
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Entity Type | Organization
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Legal Business Name | E GONZALEZ COUNSELING, PLLC
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 1660 N MAPLE RD
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City | ANN ARBOR
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State | MI
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Zip | 48103-2468
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Country | US
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Telephone | 512-587-4314
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Fax |
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Provider Business Mailing Address
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Address Line | 214 S MAIN ST STE 204
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City | ANN ARBOR
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State | MI
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Zip | 48104-2122
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Country | US
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Telephone | 734-926-5314
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | ELIZABETH GONZALEZ
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Credential | LMSW
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Telephone | 734-926-5314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801093669
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License Number State | MI
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