Provider Demographics
NPI:1619764404
Name:GOOCH, AVIANCE (MS, LCMHC-A)
Entity type:Individual
Prefix:
First Name:AVIANCE
Middle Name:
Last Name:GOOCH
Suffix:
Gender:
Credentials:MS, LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 COVE POINT DR APT 20
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4916
Mailing Address - Country:US
Mailing Address - Phone:919-330-6133
Mailing Address - Fax:
Practice Address - Street 1:3820 MERTON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6609
Practice Address - Country:US
Practice Address - Phone:919-646-5783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health