Provider Demographics
NPI:1629022884
Name:GOLD, YAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:YAEL
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2414103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164HOtherBLUE CROSS BLUE SHIELD
NC6000019Medicaid
NC2822444Medicare ID - Type Unspecified