Provider Demographics
NPI:1861040875
Name:GONZALES, MONICA N (LADAC)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:N
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:N
Other - Last Name:ORTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADAC
Mailing Address - Street 1:1615 OJO COURT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401
Mailing Address - Country:US
Mailing Address - Phone:505-564-4804
Mailing Address - Fax:505-564-4857
Practice Address - Street 1:1615 OJO COURT
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-564-4804
Practice Address - Fax:505-564-4857
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0998101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)