Provider Demographics
NPI:1013420892
Name:GONZALEZ, DEBORA (LGPC)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 15TH ST S APT 908
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-5037
Mailing Address - Country:US
Mailing Address - Phone:434-426-7953
Mailing Address - Fax:
Practice Address - Street 1:601 50TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5450
Practice Address - Country:US
Practice Address - Phone:202-399-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LGPC00129OtherLGPC - LICENSE