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General NPI Number Information
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NPI Number | 1689861387
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Entity Type | Individual
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Provider Name | VICTOR GONZALEZ JR. PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 3380 TRICKUM RD BUILDING 1000, SUITE 102
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City | WOODSTOCK
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State | GA
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Zip | 30188-3680
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Country | US
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Telephone | 770-924-9700
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Fax | 770-926-0690
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Provider Business Mailing Address
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Address Line | 4520 CLUB HOUSE DR
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City | MARIETTA
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State | GA
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Zip | 30066-2473
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Country | US
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Telephone | 404-245-7143
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY002448
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY002448
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License Number State | GA
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