Healthcare Provider Details

I. General information

NPI: 1295673788
Provider Name (Legal Business Name): IREDELL-STATESVILLE SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 N RACE ST
STATESVILLE NC
28677-3915
US

IV. Provider business mailing address

549 N RACE ST
STATESVILLE NC
28677-3915
US

V. Phone/Fax

Practice location:
  • Phone: 704-873-9432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MS. CASEY GOUGH
Title or Position: SCHOOL PSYCHOLOGIST
Credential: SSP, MA, NCSP
Phone: 980-306-4962