Basic Information
| Provider Information | |||||||||
| NPI: | 1508096033 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLL | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MSW LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 CRESTBROOK DR | ||||||||
| Address2: | |||||||||
| City: | ARDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287042614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285822279 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 OAK PLZ | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288013008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282522501 | ||||||||
| FaxNumber: | 8282522701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2009 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CW016573 | PA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | C006770 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6007580 | 05 | NC | MEDICAID |