Provider Demographics
NPI:1588664163
Name:GOOLSBY, DAVID ARTHUR (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ARTHUR
Last Name:GOOLSBY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:ARTHUR
Other - Last Name:MORGAN-GOOLSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-CC
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457
Mailing Address - Country:US
Mailing Address - Phone:207-794-8990
Mailing Address - Fax:207-403-9093
Practice Address - Street 1:26B ENFIELD RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-1190
Practice Address - Country:US
Practice Address - Phone:207-794-8990
Practice Address - Fax:207-403-9093
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC67151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431819099Medicaid
MEME1205Medicare PIN