Healthcare Provider Details

I. General information

NPI: 1508748062
Provider Name (Legal Business Name): AUTUMN GRACE GODDARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MORGANTON BLVD SW
LENOIR NC
28645
US

IV. Provider business mailing address

352 SEVEN OAKS RD
BOONE NC
28607-9161
US

V. Phone/Fax

Practice location:
  • Phone: 828-394-5563
  • Fax:
Mailing address:
  • Phone: 828-406-2558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: