Provider Demographics
NPI:1508166521
Name:GONZALEZ, ROXANNA (MA LISAC LAC)
Entity Type:Individual
Prefix:MS
First Name:ROXANNA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA LISAC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 E PALMDALE ST STE 110130
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-1857
Mailing Address - Country:US
Mailing Address - Phone:520-792-5704
Mailing Address - Fax:520-792-5724
Practice Address - Street 1:802 E 46TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-5006
Practice Address - Country:US
Practice Address - Phone:520-622-3553
Practice Address - Fax:520-792-5724
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC1164101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)