Healthcare Provider Details

I. General information

NPI: 1669303111
Provider Name (Legal Business Name): GOAL LINE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 SHANNON RD STE 358
DURHAM NC
27707-6330
US

IV. Provider business mailing address

3511 SHANNON RD STE 358
DURHAM NC
27707-6330
US

V. Phone/Fax

Practice location:
  • Phone: 919-928-4204
  • Fax:
Mailing address:
  • Phone: 919-928-4204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN LLOYD BAUGHAM
Title or Position: QP
Credential:
Phone: 336-471-0149