Basic Information
| Provider Information | |||||||||
| NPI: | 1922612654 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ PEREZ | ||||||||
| FirstName: | ELIDE | ||||||||
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| Credential: | LCSWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1154 BROOKLYN AVE | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287926410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285515284 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 RIDGEFIELD BLVD STE 190 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288066211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286707723 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2020 | ||||||||
| LastUpdateDate: | 09/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P014782 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.