Provider Demographics
NPI:1952610560
Name:GOLDSTON, ANGLE M (MS, QP, CPSS, LCAS-A)
Entity Type:Individual
Prefix:MRS
First Name:ANGLE
Middle Name:M
Last Name:GOLDSTON
Suffix:
Gender:F
Credentials:MS, QP, CPSS, LCAS-A
Other - Prefix:MRS
Other - First Name:ANGLE
Other - Middle Name:
Other - Last Name:GOLDSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, QP, CPSS, LCAS-A
Mailing Address - Street 1:5135 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1339
Mailing Address - Country:US
Mailing Address - Phone:336-324-7761
Mailing Address - Fax:
Practice Address - Street 1:5135 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-1339
Practice Address - Country:US
Practice Address - Phone:336-324-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-1048-01174400000X
NCLCASA-20069101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2013-1048-01OtherNORTH CAROLINA CERTIFIED PEER SUPPORT SPECIALIST
NCLCASA-20069OtherNC SUBSTANCE ABUSE PROFESSIONAL BOARD