Healthcare Provider Details

I. General information

NPI: 1861304958
Provider Name (Legal Business Name): TRISHA GOODALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 SACHEM PL
CHARLOTTESVILLE VA
22901-2560
US

IV. Provider business mailing address

2732 MCELROY DR
CHARLOTTESVILLE VA
22903-4143
US

V. Phone/Fax

Practice location:
  • Phone: 434-218-0405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: