Provider Demographics
NPI:1770987083
Name:GONZALEZ, STEPHANIE ANN (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W HOLMES RD STE 143
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0435
Mailing Address - Country:US
Mailing Address - Phone:517-410-0311
Mailing Address - Fax:517-507-4888
Practice Address - Street 1:913 W HOLMES RD STE 143
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0435
Practice Address - Country:US
Practice Address - Phone:517-410-0311
Practice Address - Fax:517-507-4888
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010888331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical