Organization
JAMES L. GONZALES COUNSELING & PSYCHOLOGICAL SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES L. GONZALES PHD (OWNER)
(770) 995-6026
Entity
Organization
Contact information
Practice address
5435 SUGARLOAF PKWY, SUITE 1103, LAWRENCEVILLE, GA 30043-5700
(770) 995-6026
(770) 995-6084
Mailing address
5435 SUGARLOAF PKWY, SUITE 1103, LAWRENCEVILLE, GA 30043-5700
(770) 995-6026
(770) 995-6084
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
1640
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00817275A
—
GA
01
—
027535
BLUE CROSS BLUE SHIELD
GA
01
—
P00264939
RAILROAD
GA
Enumeration date
03/21/2012
Last updated
03/21/2012
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