Healthcare Provider Details

I. General information

NPI: 1437875341
Provider Name (Legal Business Name): SHARENA C GOOSUN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 NUCKOLS RD STE 100
GLEN ALLEN VA
23060-9276
US

IV. Provider business mailing address

10900 NUCKOLS RD STE 100
GLEN ALLEN VA
23060-9276
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax: 804-977-6365
Mailing address:
  • Phone: 804-207-6737
  • Fax: 804-977-6365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704015382
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016211
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0709024768
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: