Healthcare Provider Details

I. General information

NPI: 1013474048
Provider Name (Legal Business Name): MORGAN ANN GOODALL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN ANN RICHARDSON BCBA

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 OAKWOOD RD STE 300
CHARLESTON WV
25314-2071
US

IV. Provider business mailing address

325 6TH AVE
SOUTH CHARLESTON WV
25303-1231
US

V. Phone/Fax

Practice location:
  • Phone: 681-265-0999
  • Fax:
Mailing address:
  • Phone: 304-720-3383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41483
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: