Healthcare Provider Details

I. General information

NPI: 1861031858
Provider Name (Legal Business Name): FELICIA ELAINE GOODRICH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20209 SENTARA WAY STE 200A
CARROLLTON VA
23314-3573
US

IV. Provider business mailing address

20209 SENTARA WAY STE 200A
CARROLLTON VA
23314-3573
US

V. Phone/Fax

Practice location:
  • Phone: 757-542-2200
  • Fax: 833-890-5189
Mailing address:
  • Phone: 757-542-2200
  • Fax: 833-890-5189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024178274
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: