Provider Demographics
NPI:1215321955
Name:GONZALEZ-GARCIA, CAROLINA (MFT)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:GONZALEZ-GARCIA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 435232
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92143-5232
Mailing Address - Country:US
Mailing Address - Phone:619-591-8939
Mailing Address - Fax:
Practice Address - Street 1:3085 BEYER BLVD STE A103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154
Practice Address - Country:US
Practice Address - Phone:619-591-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41111106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist