Provider Demographics
NPI:1790585776
Name:GONZALEZ, GINA (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 KODY MARIE CT APT 432
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4575
Mailing Address - Country:US
Mailing Address - Phone:845-728-7062
Mailing Address - Fax:
Practice Address - Street 1:301 MCCULLOUGH DR STE 435
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3310
Practice Address - Country:US
Practice Address - Phone:704-504-7274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0216381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical