Provider Demographics
NPI:1134980212
Name:GOINS, DIJON (LCMHCA)
Entity type:Individual
Prefix:
First Name:DIJON
Middle Name:
Last Name:GOINS
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 ALBRIGHT RD NW APT 107
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-0072
Mailing Address - Country:US
Mailing Address - Phone:704-949-9657
Mailing Address - Fax:
Practice Address - Street 1:5160 ALBRIGHT RD NW APT 107
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-0072
Practice Address - Country:US
Practice Address - Phone:704-949-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health