Provider Demographics
NPI:1477695732
Name:GONZALEZ, ANITA (LCPC)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19020 CAPEHART DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3935
Mailing Address - Country:US
Mailing Address - Phone:301-237-9487
Mailing Address - Fax:
Practice Address - Street 1:615 S FREDERICK AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1240
Practice Address - Country:US
Practice Address - Phone:301-237-9487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional