Healthcare Provider Details

I. General information

NPI: 1881651347
Provider Name (Legal Business Name): GOLDSBORO COUNSELING CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MALLOY ST UNIT E
GOLDSBORO NC
27534-4478
US

IV. Provider business mailing address

208 MALLOY ST UNIT E
GOLDSBORO NC
27534-4478
US

V. Phone/Fax

Practice location:
  • Phone: 919-778-5594
  • Fax: 919-778-5633
Mailing address:
  • Phone: 919-778-5594
  • Fax: 919-778-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3426
License Number StateNC

VIII. Authorized Official

Name: MRS. KARLA JEFFREYS
Title or Position: OWNER
Credential:
Phone: 919-778-5594