Healthcare Provider Details

I. General information

NPI: 1730711722
Provider Name (Legal Business Name): GOLSON FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 COPPERFIELD BLVD NE
CONCORD NC
28025-2433
US

IV. Provider business mailing address

4892 HORSEBACK LN
HARRISBURG NC
28075-0350
US

V. Phone/Fax

Practice location:
  • Phone: 809-701-9900
  • Fax: 704-788-1114
Mailing address:
  • Phone: 914-565-1923
  • Fax: 704-788-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DIONNE GOLSON
Title or Position: OWNER
Credential:
Phone: 914-565-1923