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General NPI Number Information
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NPI Number | 1104521558
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Entity Type | Individual
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Provider Name | NICOLE MARIE GOODWILL CDCA
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Gender | Female
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Dates
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Enumeration Date | 04/04/2023
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 905 N MAIN ST
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City | FINDLAY
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State | OH
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Zip | 45840-3670
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Country | US
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Telephone | 567-525-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 316 1/2 N CUMBERLAND ST
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City | ARLINGTON
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State | OH
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Zip | 45814-8791
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Country | US
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Telephone | 937-209-1215
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | APS.003604
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA187534
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License Number State | OH
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