Organization
LISA S GONZENBACH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA GONZENBACH (OWNER)
(205) 750-0181
Entity
Organization
Contact information
Practice address
3600 WATERMELON RD, SUITE 202, NORTHPORT, AL 35473-5169
(205) 750-0181
Mailing address
3600 WATERMELON RD, SUITE 202, NORTHPORT, AL 35473-5169
(205) 750-0181
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0969C
AL
Other
Enumeration date
09/25/2013
Last updated
01/23/2014
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