Healthcare Provider Details

I. General information

NPI: 1689894404
Provider Name (Legal Business Name): DAVID GOLDSTROM LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 SHEFFIELD DRIVE NE
BROOKHAVEN GA
30329-3451
US

IV. Provider business mailing address

1346 SHEFFIELD DR NE
BROOKHAVEN GA
30329-3451
US

V. Phone/Fax

Practice location:
  • Phone: 404-870-8075
  • Fax: 404-692-7280
Mailing address:
  • Phone: 404-870-8075
  • Fax: 404-692-7280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000675
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number0000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: