Healthcare Provider Details

I. General information

NPI: 1760934343
Provider Name (Legal Business Name): GOODWIN PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 W MAIN ST SUITE D
HAMLET NC
28345-3636
US

IV. Provider business mailing address

PO BOX 1718
HAMLET NC
28345-1718
US

V. Phone/Fax

Practice location:
  • Phone: 910-557-0044
  • Fax: 910-716-9177
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4762
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number4762
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number4762
License Number StateNC

VIII. Authorized Official

Name: DR. TANYA GOODWIN-BALDWIN
Title or Position: OWNER/LICENSED PSYCHOLOGIST
Credential: HSP-P
Phone: 910-557-0044