Provider Demographics
NPI:1366853129
Name:COLLINS, GIOVANNA GOMEZ (LCSW)
Entity type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:GOMEZ
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GIOVANNA
Other - Middle Name:LEIGH
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:10130 PERIMETER PKWY # 221
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2447
Mailing Address - Country:US
Mailing Address - Phone:704-832-2200
Mailing Address - Fax:
Practice Address - Street 1:10130 PERIMETER PKWY # 221
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-2447
Practice Address - Country:US
Practice Address - Phone:704-832-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0083191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical