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 1:121 KENT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-8747
Mailing Address - Country:US
Mailing Address - Phone:219-707-0262
Mailing Address - Fax:
Practice Address - Street 1:3421 GENTLE BREEZE DR STE A
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2549
Practice Address - Country:US
Practice Address - Phone:410-953-8506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC006973363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health