Individual
MS. LAURA LISA GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A
Contact information
Practice address
7134 BLANKENSHIP CIR, DAVISON, MI 48423-2317
(810) 742-7713
(810) 407-9198
Mailing address
510 W FOSS AVE, FLINT, MI 48505-2087
(810) 835-9841
(810) 407-9198
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
AS25.293461
MI
Other
Enumeration date
09/17/2020
Last updated
09/17/2020
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