Individual
IVAN GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2817 REILLY ROAD, WOMACK ARMY MEDICAL CENTER, FORT BRAGG, NC 28310
(910) 907-8922
(910) 907-6069
Mailing address
6600 VAN AALST BLVD, FORT MOORE, GA 31905-2102
(706) 545-4237
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-004598
AZ
Other
Enumeration date
01/13/2015
Last updated
10/11/2024
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