Healthcare Provider Details

I. General information

NPI: 1295438984
Provider Name (Legal Business Name): DESTINY ROSE GOODSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 E MAIN ST
ABINGDON VA
24210-3408
US

IV. Provider business mailing address

PO BOX 11247
RICHMOND VA
23230-1247
US

V. Phone/Fax

Practice location:
  • Phone: 540-240-9029
  • Fax: 540-765-4118
Mailing address:
  • Phone: 877-566-9624
  • Fax: 804-237-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0709025109
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016534
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: