Provider Demographics
NPI:1083395339
Name:CLEAR FOUNDATIONS THERAPY AND ASSESSMENT PLLC
Entity Type:Organization
Organization Name:CLEAR FOUNDATIONS THERAPY AND ASSESSMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPA
Authorized Official - Phone:704-837-2473
Mailing Address - Street 1:5113 PIPER STATION DR STE 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5113 PIPER STATION DR STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6652
Practice Address - Country:US
Practice Address - Phone:704-378-8595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty