Provider Demographics
NPI:1558855106
Name:HURLSTON GONZALEZ, VIVIAN (MSW, LCSW, LCASA)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:HURLSTON GONZALEZ
Suffix:
Gender:F
Credentials:MSW, LCSW, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 FALSTAFF RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1813
Mailing Address - Country:US
Mailing Address - Phone:919-615-1027
Mailing Address - Fax:
Practice Address - Street 1:3012 FALSTAFF RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1813
Practice Address - Country:US
Practice Address - Phone:919-615-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0135931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical