Healthcare Provider Details

I. General information

NPI: 1477784296
Provider Name (Legal Business Name): MR. YOHANCE S GOODRICH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 N 25TH ST
RICHMOND VA
23223-6539
US

IV. Provider business mailing address

8245 GRAVES RD
PETERSBURG VA
23803-1209
US

V. Phone/Fax

Practice location:
  • Phone: 804-643-0002
  • Fax: 804-643-3106
Mailing address:
  • Phone: 804-712-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: