Provider Demographics
NPI:1982444261
Name:GOLDY, GRACE S (LPCA)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:S
Last Name:GOLDY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SOWELL ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2682
Mailing Address - Country:US
Mailing Address - Phone:908-956-4710
Mailing Address - Fax:
Practice Address - Street 1:1012 ANNA KNAPP EXT
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5400
Practice Address - Country:US
Practice Address - Phone:908-956-4710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8916101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty