MEDICARE: SAMANTHA GONZALEZ LCSW

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1265164776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA GONZALEZ LCSW

Provider Business Mailing Address
First Line	:	1 HUNTINGTON RD STE 703
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-7214
Country	:	US
Telephone Number	:	706-425-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2298 BROCKETT RD
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-4414
Country	:	US
Telephone Number	:	706-425-8900
Fax Number	:

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

Provider Enumeration Date	:	06/24/2022
Last Update Date	:	01/08/2026

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