Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401013635 | MI |
NPI | 1003256413 |
---|---|
Provider Name | Mrs. Gabriella Ann Gonzales |
First Address | Southfield, MI 48033-6007 |
Second Address | Southfield, MI 48033-6007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2013 |
Last Update Date | 10/04/2015 |