Healthcare Provider Details

I. General information

NPI: 1447170352
Provider Name (Legal Business Name): MATTHEW DALE GOUCHOE-HANAS LCSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

101 THOMAS LN APT C3
CARRBORO NC
27510-1362
US

IV. Provider business mailing address

101 THOMAS LN APT C3
CARRBORO NC
27510-1362
US

V. Phone/Fax

Practice location:
  • Phone: 919-590-3948
  • Fax:
Mailing address:
  • Phone: 919-590-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024126
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: