Individual
DEREK MARK GOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
224 EAST ST, SUITE A, PITTSBORO, NC 27312-9750
(919) 542-0747
Mailing address
224 EAST ST, SUITE A, PITTSBORO, NC 27312-9750
(919) 542-0747
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2369
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6103515
—
NC
Enumeration date
02/20/2007
Last updated
06/25/2009
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