Provider Demographics
NPI:1164473195
Name:FAMILY PSYCHOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:FAMILY PSYCHOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-299-9945
Mailing Address - Street 1:510 N ELAM AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1150
Mailing Address - Country:US
Mailing Address - Phone:336-299-9945
Mailing Address - Fax:
Practice Address - Street 1:510 N ELAM AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1150
Practice Address - Country:US
Practice Address - Phone:336-299-9945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2346153Medicare ID - Type Unspecified