Provider Demographics
NPI:1063103760
Name:GONZALES, ADALYNN MARIA
Entity type:Individual
Prefix:MISS
First Name:ADALYNN
Middle Name:MARIA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ADDY
Other - Middle Name:MARIA
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:307 VERMILLION ST
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-1407
Mailing Address - Country:US
Mailing Address - Phone:678-832-9581
Mailing Address - Fax:
Practice Address - Street 1:307 VERMILLION ST
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-1407
Practice Address - Country:US
Practice Address - Phone:678-832-9581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician