Healthcare Provider Details

I. General information

NPI: 1144266792
Provider Name (Legal Business Name): ANITA SCHAFER GODWIN M.S,, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 WHEELER RD SUITE 110
AUGUSTA GA
30909-6549
US

IV. Provider business mailing address

631 CROWN POINT DR
MARTINEZ GA
30907-9056
US

V. Phone/Fax

Practice location:
  • Phone: 706-855-7784
  • Fax: 706-651-1090
Mailing address:
  • Phone: 706-825-4731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC001808
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: