Provider Demographics
NPI:1568058394
Name:GONZALEZ, NATASHA (LPC)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
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 1:7020 BIRCHETT DR
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-1743
Mailing Address - Country:US
Mailing Address - Phone:804-514-5290
Mailing Address - Fax:
Practice Address - Street 1:7020 BIRCHETT DR
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1743
Practice Address - Country:US
Practice Address - Phone:804-514-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
VA0701010153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health