Provider Demographics
NPI:1538496013
Name:GONZALEZ, MICHELLE L (CADC II, ICADC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CADC II, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 N CHIPPEWA AVE
Mailing Address - Street 2:210
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4444
Mailing Address - Country:US
Mailing Address - Phone:323-382-2457
Mailing Address - Fax:
Practice Address - Street 1:1525 E 17TH ST
Practice Address - Street 2:UNIT B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8521
Practice Address - Country:US
Practice Address - Phone:714-542-0400
Practice Address - Fax:714-542-0404
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7060OtherDMC N