Healthcare Provider Details

I. General information

NPI: 1144757147
Provider Name (Legal Business Name): CHERELLE GOODE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7918 JONES BRANCH DR
MC LEAN VA
22102-3337
US

IV. Provider business mailing address

7918 JONES BRANCH DR STE 400
MC LEAN VA
22102-3319
US

V. Phone/Fax

Practice location:
  • Phone: 757-828-3832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007023
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: