Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1446 | NC |
Y | 103T00000X | Psychologist | 1446 | NC |
NPI | 1003930785 |
---|---|
Provider Name | Ms. Christine Miskinis Goodrich |
First Address | Boone, NC 28607-7814 |
Second Address | Boone, NC 28607-7814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 15/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
046MA | BLUE CROSS BLUE SHEILD (01) | NC |