Healthcare Provider Details

I. General information

NPI: 1790947406
Provider Name (Legal Business Name): MS. RASHAWNDA S GOODEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 COMMERCE ST
MANNING SC
29102-2638
US

IV. Provider business mailing address

215 N MAGNOLIA ST
SUMTER SC
29150-4943
US

V. Phone/Fax

Practice location:
  • Phone: 803-435-2124
  • Fax: 803-435-8113
Mailing address:
  • Phone: 803-775-9364
  • Fax: 803-773-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: