Provider Demographics
NPI:1790344307
Name:GONZALEZ PEREZ, ANGELA NIKOLE (MS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:NIKOLE
Last Name:GONZALEZ PEREZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:2750 OLD ALABAMA RD UNIT 200
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022
Mailing Address - Country:US
Mailing Address - Phone:678-893-5300
Mailing Address - Fax:
Practice Address - Street 1:2750 OLD ALABAMA RD UNIT 200
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022
Practice Address - Country:US
Practice Address - Phone:678-893-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor