Healthcare Provider Details

I. General information

NPI: 1760391775
Provider Name (Legal Business Name): HALEY GOODMAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9414 BELAIR RD STE 201
NOTTINGHAM MD
21236-1542
US

IV. Provider business mailing address

9414 BELAIR RD STE 201
NOTTINGHAM MD
21236-1542
US

V. Phone/Fax

Practice location:
  • Phone: 410-529-2151
  • Fax:
Mailing address:
  • Phone: 410-529-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC18422
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: