Healthcare Provider Details

I. General information

NPI: 1952610560
Provider Name (Legal Business Name): ANGLE M GOLDSTON MS, QP, CPSS, LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGLE GOLDSTON MS, QP, CPSS, LCAS-A

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5135 N CHURCH ST
GREENSBORO NC
27455-1339
US

IV. Provider business mailing address

5135 N CHURCH ST
GREENSBORO NC
27455-1339
US

V. Phone/Fax

Practice location:
  • Phone: 336-324-7761
  • Fax:
Mailing address:
  • Phone: 336-324-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCASA-20069
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2013-1048-01
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: