Provider Demographics
NPI:1619783149
Name:GONZALEZ, DONNA STEPHANIE (MS AMFT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:STEPHANIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS AMFT
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:STEPHANIE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, MS AMFT
Mailing Address - Street 1:410 W FALLBROOK AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6191
Mailing Address - Country:US
Mailing Address - Phone:559-472-0501
Mailing Address - Fax:
Practice Address - Street 1:201 E MAIN ST UNIT N
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4476
Practice Address - Country:US
Practice Address - Phone:805-364-2105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist