Provider Demographics
NPI:1376774588
Name:GOSS, HOLLY MEREDITH (LPC-BE)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MEREDITH
Last Name:GOSS
Suffix:
Gender:F
Credentials:LPC-BE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 NC HWY 65
Practice Address - Street 2:
Practice Address - City:WENTWORTH
Practice Address - State:NC
Practice Address - Zip Code:27375-0355
Practice Address - Country:US
Practice Address - Phone:336-342-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor