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Mark Gonzales, LAADC-CALCI10970318
Addiction (Substance Use Disorder) Counselor in Visalia, California
NPI 1619306289

Mark Gonzales is an Addiction (Substance Use Disorder) Counselor based in Visalia, CA and is specialized in Addiction (Substance Use Disorder). Mark Gonzales practices in Visalia, CA and has the professional credentials of LAADC-CALCI10970318. The NPI Number for Mark Gonzales is 1619306289 and holds a License No. 5465630291 (California).

The current practice location address for Mark Gonzales is 4023 W Douglas Ave, Visalia, CA and can be reached out via phone at 510-691-0474.

Location: 4023 W Douglas Ave, Visalia, CA, 93291-4185
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1619306289
Provider Name
Mark Gonzales
Credential
LAADC-CALCI10970318
Provider Entity Type
Individual
Gender
Male
Address
4023 W Douglas Ave, Visalia, CA, 93291-4185
Phone Number
510-691-0474
Fax Number
Provider Enumeration Date
11/04/2013
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
168767 01 CA ADDICTION COUNSELOR CERTIFICATION BOARD OF CALIFORNIA
institution
Provider Business Practice Location Address Details
Address
4023 W Douglas Ave
City
Visalia
State
California
Zip
93291-4185
Phone Number
510-691-0474
Fax Number
person
Provider Business Mailing Address Details
Address
4023 W Douglas Ave
City
Visalia
State
California
Zip
93291-4185
Phone Number
510-691-0474
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
LCI10970318 (California)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
5465630291 (California)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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