Individual
JACQUELINE GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPCC, BS,CDCA
Contact information
Practice address
400 BOWMAN ST, MANSFIELD, OH 44903-1235
(419) 525-3525
Mailing address
400 BOWMAN ST, MANSFIELD, OH 44903-1235
(419) 525-3525
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
165387
OH
Other
Enumeration date
06/27/2018
Last updated
06/27/2018
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