Provider Demographics
NPI:1720865231
Name:GOULDING, RENEE MARIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:GOULDING
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 STONEHEDGE CT
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1154
Mailing Address - Country:US
Mailing Address - Phone:219-707-0262
Mailing Address - Fax:
Practice Address - Street 1:600 JULIAN LN STE 640
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7812
Practice Address - Country:US
Practice Address - Phone:828-552-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018786363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health