Individual
LUZ AMALYA GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSAC, RESIDENT IN CO
Contact information
Practice address
120 FALCON DR, SUITE 6, FREDERICKSBURG, VA 22408-1900
(540) 479-2064
Mailing address
PO BOX 42178, FREDERICKSBURG, VA 22404-2178
(540) 479-2064
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0710102137
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DON'T HAVE
—
VA
01
—
DON'T HAVE NEW
MAGELLAN NETWORK PROVIDER
VA
Enumeration date
04/05/2017
Last updated
04/05/2017
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