Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 5709 | SC |
NPI | 1003261207 |
---|---|
Provider Name | Timothy Goode |
First Address | Columbia, SC 29203-6859 |
Second Address | Columbia, SC 29203-6859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2016 |
Last Update Date | 27/04/2016 |