Individual
MS. KELLY H GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-5313
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW0000004347
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
334969
VALUE OPTIONS GROUP
—
01
—
4117927
MAGELLAN NAVIGATOR
—
01
—
620582605
INTIAL GROUP GROUP
—
Enumeration date
09/12/2006
Last updated
05/11/2024
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