Provider Demographics
NPI:1720198609
Name:DR. YAEL GOLD, P.C.
Entity Type:Organization
Organization Name:DR. YAEL GOLD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-799-6162
Mailing Address - Street 1:5201 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7020
Mailing Address - Country:US
Mailing Address - Phone:910-799-6162
Mailing Address - Fax:910-799-6171
Practice Address - Street 1:5201 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7020
Practice Address - Country:US
Practice Address - Phone:910-799-6162
Practice Address - Fax:910-799-6171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2414103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000019Medicaid
NC1164HOtherBLUE CROSS BLUE SHIEL
NC6000019Medicaid