Provider Demographics
NPI:1790352540
Name:GOLDSTON, FAITH
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:GOLDSTON
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 1:624 RIPPLING STREAM RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1233
Mailing Address - Country:US
Mailing Address - Phone:919-799-6350
Mailing Address - Fax:
Practice Address - Street 1:624 RIPPLING STREAM RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1233
Practice Address - Country:US
Practice Address - Phone:919-799-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0161541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical