Provider Demographics
NPI:1104538487
Name:GONZALEZ, CANDI A (LCSW-S)
Entity type:Individual
Prefix:
First Name:CANDI
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MARKET ST STE 600
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-1532
Mailing Address - Country:US
Mailing Address - Phone:409-762-8636
Mailing Address - Fax:
Practice Address - Street 1:10000 EMMETT F LOWRY EXPY STE 4000300D
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2127
Practice Address - Country:US
Practice Address - Phone:409-762-8636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX615721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty