Provider Demographics
NPI:1205253598
Name:GOLD, JENNIFER (LPCA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-1536
Mailing Address - Country:US
Mailing Address - Phone:828-430-4388
Mailing Address - Fax:828-437-4999
Practice Address - Street 1:617 S GREEN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3517
Practice Address - Country:US
Practice Address - Phone:828-437-3000
Practice Address - Fax:828-437-4999
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10773101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA10773OtherLICENSE