Provider Demographics
NPI:1831406388
Name:GONZALES, CHANDA LISE (LISAC, LPC)
Entity type:Individual
Prefix:MRS
First Name:CHANDA
Middle Name:LISE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LISAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16042 N 32ND ST STE B-13
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3806
Mailing Address - Country:US
Mailing Address - Phone:480-630-4067
Mailing Address - Fax:480-304-3121
Practice Address - Street 1:16042 N 32ND ST STE B-13
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3806
Practice Address - Country:US
Practice Address - Phone:480-630-4067
Practice Address - Fax:480-304-3121
Is Sole Proprietor?:No
Enumeration Date:2010-09-04
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-15077101YA0400X
AZLPC-17147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)