Healthcare Provider Details

I. General information

NPI: 1356692388
Provider Name (Legal Business Name): JEANNETTE R ABELSON-GOODE LCSW, CSOTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N COURTHOUSE RD SUITE 101
NORTH CHESTERFIELD VA
23236-4069
US

IV. Provider business mailing address

703 N COURTHOUSE RD SUITE 101
NORTH CHESTERFIELD VA
23236-4069
US

V. Phone/Fax

Practice location:
  • Phone: 804-794-4482
  • Fax: 804-379-7578
Mailing address:
  • Phone: 804-794-4482
  • Fax: 804-379-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005346
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0812000410
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: