Provider Demographics
NPI:1689165193
Name:GONZALEZ, JAZMIN STEPHANIE (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:STEPHANIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 FALLS DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-5533
Mailing Address - Country:US
Mailing Address - Phone:919-809-3286
Mailing Address - Fax:
Practice Address - Street 1:1106 KINGOLD BLVD
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-1619
Practice Address - Country:US
Practice Address - Phone:252-747-2921
Practice Address - Fax:252-747-4915
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24538101YA0400X
NCP0123961041C0700X
NCC0133371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)