Gough, Derek Mark
Gough, Derek Mark is an sole proprietor health care provider with primary practice located at 224 East St Suite A, Pittsboro NC 27312-9750. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Gough, Derek Mark can be contacted via phone (919) 542-0747.Contact Information
Primary practice address
224 East St Suite A
Pittsboro NC 27312-9750
Phone: (919) 542-0747
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 2369 | North Carolina |
Profile Details
| NPI number | 1528103546 |
|---|---|
| LBN Legal business name | Gough, Derek Mark |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 20th, 2007 |
| Last updated | Jun 25th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528103546 | NPPES |
| North Carolina | MEDICAID | 6103515 |
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