Provider Demographics
NPI:1962163253
Name:GONZALEZ, NINIVE ALICIA (LPC)
Entity type:Individual
Prefix:
First Name:NINIVE
Middle Name:ALICIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10303 DUNLAP
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78252-4471
Mailing Address - Country:US
Mailing Address - Phone:956-336-5475
Mailing Address - Fax:
Practice Address - Street 1:10303 DUNLAP
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78252-4471
Practice Address - Country:US
Practice Address - Phone:956-336-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional