Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC004357 | GA |
N | 101YS0200X | School Counselor |
NPI | 1164793436 |
---|---|
Provider Name | Ms. Tere P Goodwin |
First Address | Fayetteville, GA 30214-7652 |
Second Address | Fayetteville, GA 30214-7652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2012 |
Last Update Date | 19/01/2012 |