Provider Demographics
NPI:1912796855
Name:JOHNSON-GONZALEZ, CHARDANAE
Entity type:Individual
Prefix:MS
First Name:CHARDANAE
Middle Name:
Last Name:JOHNSON-GONZALEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 SENECA CLUB LOOP # 2-103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-3191
Mailing Address - Country:US
Mailing Address - Phone:407-496-1247
Mailing Address - Fax:
Practice Address - Street 1:3890 DUNN AVE STE 1104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6432
Practice Address - Country:US
Practice Address - Phone:904-765-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health