Provider Demographics
NPI:1326710641
Name:GOLDSMITH, CASSANDRA LATRICE
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:LATRICE
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 BINDON LN
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7327
Mailing Address - Country:US
Mailing Address - Phone:864-467-3732
Mailing Address - Fax:864-467-3765
Practice Address - Street 1:130 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3241
Practice Address - Country:US
Practice Address - Phone:864-467-3790
Practice Address - Fax:864-467-3765
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC570542729101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC570542729Medicaid