Provider Demographics
NPI:1811505126
Name:GONZALEZ, KIARA J
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:J
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6837 WILLOWBROOK LN APT 6837
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-5360
Mailing Address - Country:US
Mailing Address - Phone:860-897-2682
Mailing Address - Fax:
Practice Address - Street 1:900 BRANCHVIEW DR NE STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2226
Practice Address - Country:US
Practice Address - Phone:704-612-6537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician