Healthcare Provider Details

I. General information

NPI: 1679493738
Provider Name (Legal Business Name): CAROLINE GRACE GONIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 NUMBER 5 SCHOOL RD NW
ASH NC
28420-2122
US

IV. Provider business mailing address

1817 BROOK PARK PL
CONWAY SC
29526-6682
US

V. Phone/Fax

Practice location:
  • Phone: 910-287-6007
  • Fax:
Mailing address:
  • Phone: 804-837-4548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number18628
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: