Provider Demographics
NPI:1508096033
Name:GOLL, PAUL DAVID JR (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:GOLL
Suffix:JR
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CRESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-2614
Mailing Address - Country:US
Mailing Address - Phone:828-582-2279
Mailing Address - Fax:
Practice Address - Street 1:1 OAK PLZ
Practice Address - Street 2:SUITE 206
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3008
Practice Address - Country:US
Practice Address - Phone:828-252-2501
Practice Address - Fax:828-252-2701
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0165731041C0700X
NCC0067701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007580Medicaid