Healthcare Provider Details

I. General information

NPI: 1720198609
Provider Name (Legal Business Name): DR. YAEL GOLD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 OLEANDER DR
WILMINGTON NC
28403-7020
US

IV. Provider business mailing address

5201 OLEANDER DR
WILMINGTON NC
28403-7020
US

V. Phone/Fax

Practice location:
  • Phone: 910-799-6162
  • Fax: 910-799-6171
Mailing address:
  • Phone: 910-799-6162
  • Fax: 910-799-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2414
License Number StateNC

VIII. Authorized Official

Name: DR. YAEL GOLD
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 901-799-6162