Healthcare Provider Details

I. General information

NPI: 1336687011
Provider Name (Legal Business Name): DEBORAH R. GOODWIN DBA A NEW DAY COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 MAITLAND CENTER COMMONS BLVD SUITE 215
MAITLAND FL
32751-7435
US

IV. Provider business mailing address

1061 MAITLAND CENTER COMMONS BLVD SUITE 215
MAITLAND FL
32751-7435
US

V. Phone/Fax

Practice location:
  • Phone: 407-260-6181
  • Fax:
Mailing address:
  • Phone: 407-260-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH9472
License Number StateFL

VIII. Authorized Official

Name: DEBORAH GOODWIN
Title or Position: MENTAL HEALTH COUNSELOR/OWNER
Credential: LMHC
Phone: 497-260-6181