Provider Demographics
NPI:1609016138
Name:GONZALES, KATHY J (CAS)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:J
Last Name:GONZALES
Suffix:
Gender:F
Credentials:CAS
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Mailing Address - Street 1:2143 HURLEY WAY, SUITE 101
Mailing Address - Street 2:NCADD-OPTIONS FOR RECOVERY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-922-5110
Mailing Address - Fax:916-922-5125
Practice Address - Street 1:2143 HURLEY WAY, SUITE 101
Practice Address - Street 2:NCADD-OPTIONS FOR RECOVERYTE
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-922-5110
Practice Address - Fax:916-922-5125
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA03070521101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)