Provider Demographics
NPI:1306216668
Name:GONZALEZ, JOANNE MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MICHELLE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 W BROAD ST APT 3123
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-4216
Mailing Address - Country:US
Mailing Address - Phone:787-210-6260
Mailing Address - Fax:
Practice Address - Street 1:2964 VINSON CT
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3505
Practice Address - Country:US
Practice Address - Phone:404-495-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional