Provider Demographics
NPI:1003643313
Name:GONZALEZ, ZACHIRA JOSEFINA (RCSWI)
Entity type:Individual
Prefix:
First Name:ZACHIRA
Middle Name:JOSEFINA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6631 ORION DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4333
Mailing Address - Country:US
Mailing Address - Phone:239-246-0381
Mailing Address - Fax:
Practice Address - Street 1:6631 ORION DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4333
Practice Address - Country:US
Practice Address - Phone:239-246-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW17535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health