Provider Demographics
NPI:1083755102
Name:GOLD, WENDY (MS, EDS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:MS, EDS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 BURNTLEAF PL
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2887
Mailing Address - Country:US
Mailing Address - Phone:336-708-0581
Mailing Address - Fax:
Practice Address - Street 1:1301 CAROLINA ST
Practice Address - Street 2:SUITE 114
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1032
Practice Address - Country:US
Practice Address - Phone:336-272-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102461Medicaid