Healthcare Provider Details

I. General information

NPI: 1689869521
Provider Name (Legal Business Name): JAMES P GOODWIN LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 WHITINGHAM DR
SILVER SPRING MD
20904-6330
US

IV. Provider business mailing address

509 WHITINGHAM DR
SILVER SPRING MD
20904-6330
US

V. Phone/Fax

Practice location:
  • Phone: 301-622-2515
  • Fax: 301-622-2515
Mailing address:
  • Phone: 301-622-2515
  • Fax: 301-622-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC0846
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: