Provider Demographics
NPI:1588233373
Name:GOUDREAU, KALYN
Entity Type:Individual
Prefix:
First Name:KALYN
Middle Name:
Last Name:GOUDREAU
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 1:3800 ARCO CORPORATE DR STE 320
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3411
Mailing Address - Country:US
Mailing Address - Phone:703-678-3032
Mailing Address - Fax:
Practice Address - Street 1:3800 ARCO CORPORATE DR STE 320
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3411
Practice Address - Country:US
Practice Address - Phone:704-978-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist