Provider Demographics
NPI:1225539372
Name:BLOCKTON-GONZALEZ, CELEBRITY (LPCC)
Entity Type:Individual
Prefix:
First Name:CELEBRITY
Middle Name:
Last Name:BLOCKTON-GONZALEZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7903 ELM AVE APT 33
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6868
Mailing Address - Country:US
Mailing Address - Phone:707-816-8323
Mailing Address - Fax:
Practice Address - Street 1:7903 ELM AVE APT 33
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6868
Practice Address - Country:US
Practice Address - Phone:707-816-8323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2022-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114895101YM0800X
CA131371106H00000X
CA9924101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor