Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 1611-C | AR |
NPI | 1003036302 |
---|---|
Provider Name | Courtney Elaine Goodrum |
First Address | Fayetteville, AR 72703-1825 |
Second Address | Fayetteville, AR 72703-1825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2007 |
Last Update Date | 20/04/2018 |