Healthcare Provider Details

I. General information

NPI: 1912839549
Provider Name (Legal Business Name): SAMANTHA GOODMAN CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CONNER DRIVE WILLOWCREST BUILDING SUITE 200
CHAPEL HILL NC
27514
US

IV. Provider business mailing address

101 CONNER DRIVE WILLOWCREST BUILDING SUITE 200
CHAPEL HILL NC
27514
US

V. Phone/Fax

Practice location:
  • Phone: 919-240-5548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number767067
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: