Provider Demographics
NPI:1316287261
Name:GONZALEZ, LISA ANN (LLMSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LLMSW
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 8224
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48107-8224
Mailing Address - Country:US
Mailing Address - Phone:323-377-5608
Mailing Address - Fax:
Practice Address - Street 1:107 S BROAD ST
Practice Address - Street 2:B-1
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2752
Practice Address - Country:US
Practice Address - Phone:517-264-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker