Provider Demographics
NPI:1548814064
Name:GUTIERREZ, LIZZIE (LCSW-A)
Entity type:Individual
Prefix:
First Name:LIZZIE
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 MOSQUERA DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-5381
Mailing Address - Country:US
Mailing Address - Phone:910-299-6643
Mailing Address - Fax:
Practice Address - Street 1:159 MAXWELL ST RM 6
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5592
Practice Address - Country:US
Practice Address - Phone:910-758-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0134291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical