Healthcare Provider Details

I. General information

NPI: 1891604807
Provider Name (Legal Business Name): DIANA LYNORA GOODIE LCSW-A
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

545 MICHAEL MARTIN RD
MOUNT OLIVE NC
28365-1131
US

IV. Provider business mailing address

545 MICHAEL MARTIN RD
MOUNT OLIVE NC
28365-1131
US

V. Phone/Fax

Practice location:
  • Phone: 252-737-3330
  • Fax: 252-737-3331
Mailing address:
  • Phone: 252-737-3330
  • Fax: 252-737-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024150
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: