Healthcare Provider Details

I. General information

NPI: 1780628651
Provider Name (Legal Business Name): SUSAN GOGGINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 COMMERCE AVE
CULLMAN AL
35055-6151
US

IV. Provider business mailing address

580 POWELL CHAPEL RD
FALKVILLE AL
35622-6219
US

V. Phone/Fax

Practice location:
  • Phone: 256-734-4688
  • Fax: 256-736-5638
Mailing address:
  • Phone: 256-739-9354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0709G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: