Provider Demographics
NPI:1629386982
Name:GONZALEZ, LORENA IVELIZ (LPC, LCMHC, LCAS)
Entity Type:Individual
Prefix:MS
First Name:LORENA
Middle Name:IVELIZ
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPC, LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 POPLAR TENT RD
Mailing Address - Street 2:SUITE 115 PMB 3083
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-9505
Mailing Address - Country:US
Mailing Address - Phone:704-954-9358
Mailing Address - Fax:
Practice Address - Street 1:8815 UNIVERSITY EAST DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4106
Practice Address - Country:US
Practice Address - Phone:980-406-5428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
VA101YP2500X
NC10838101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional