Provider Demographics
NPI:1982426458
Name:GONZALEZ MELENDEZ, YOLIMAR (CDCA PRE)
Entity type:Individual
Prefix:
First Name:YOLIMAR
Middle Name:
Last Name:GONZALEZ MELENDEZ
Suffix:
Gender:F
Credentials:CDCA PRE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 CORONADO AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1359
Mailing Address - Country:US
Mailing Address - Phone:330-701-5217
Mailing Address - Fax:
Practice Address - Street 1:29 NORTH RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-1918
Practice Address - Country:US
Practice Address - Phone:330-652-6770
Practice Address - Fax:330-652-2069
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.190361101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)