Provider Demographics
NPI:1902231913
Name:GONZALEZ, CARSON MCRAE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:MCRAE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 DOMINICA CIR W
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4069
Mailing Address - Country:US
Mailing Address - Phone:336-707-3607
Mailing Address - Fax:
Practice Address - Street 1:241 DOMINICA CIR W
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-4069
Practice Address - Country:US
Practice Address - Phone:336-707-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0098521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical