Individual
JOHN EDWARD GOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MHP
Contact information
Practice address
2715 COLONIAL DR BLDG 200A, COLUMBIA, SC 29203-6818
(803) 898-4850
Mailing address
114 WATERVILLE DR, COLUMBIA, SC 29229-8141
(803) 865-8439
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20048848
—
SC
Enumeration date
11/03/2020
Last updated
11/03/2020
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