Individual
LISA MARIE GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDC
Contact information
Practice address
3701 W COMMERCE ST, SAN ANTONIO, TX 78207-3611
(210) 434-0531
(210) 434-0321
Mailing address
3701 W COMMERCE ST, SAN ANTONIO, TX 78207-3611
(210) 434-0531
(210) 434-0321
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14502
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14548732
—
TX
Enumeration date
09/19/2019
Last updated
09/19/2019
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