Provider Demographics
NPI:1689894404
Name:GOLDSTROM, DAVID (LMFT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GOLDSTROM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 SHEFFIELD DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3451
Mailing Address - Country:US
Mailing Address - Phone:404-870-8075
Mailing Address - Fax:404-692-7280
Practice Address - Street 1:1346 SHEFFIELD DRIVE NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-3451
Practice Address - Country:US
Practice Address - Phone:404-870-8075
Practice Address - Fax:404-692-7280
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000675106H00000X
NY0000101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral