Healthcare Provider Details

I. General information

NPI: 1952215907
Provider Name (Legal Business Name): KYLEIGH GOODMAN M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19900 W CATAWBA AVE STE 302
CORNELIUS NC
28031-4084
US

IV. Provider business mailing address

19900 W CATAWBA AVE STE 302
CORNELIUS NC
28031-4084
US

V. Phone/Fax

Practice location:
  • Phone: 704-626-5964
  • Fax:
Mailing address:
  • Phone: 704-626-5964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2855520
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: