Individual
JAMES L GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
5435 SUGARLOAF PKWY, SUITE 1103, LAWRENCEVILLE, GA 30043-7831
(770) 995-6026
Mailing address
5435 SUGARLOAF PKWY, SUITE 1103, LAWRENCEVILLE, GA 30043-7831
(770) 995-6026
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
1640
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00817275A
—
GA
01
—
027535
BLUE CROSS BLUE SHIELD
GA
01
—
P00264939
RAILROAD
GA
Enumeration date
08/18/2006
Last updated
07/08/2007
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