MEDICARE: KRISTIN GONITZKE LMFTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	12503A	NC

General Provider Information

NPI Number	:	1023715414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN GONITZKE LMFTA

Provider Business Mailing Address
First Line	:	PO BOX 1225
Second Line	:
City	:	SKYLAND
State	:	NC
Zip	:	28776-1225
Country	:	US
Telephone Number	:	828-367-7716
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 E CHESTNUT ST STE 6
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-2480
Country	:	US
Telephone Number	:	828-367-7716
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	02/15/2023

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