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General NPI Number Information
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NPI Number | 1164244729
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Entity Type | Individual
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Provider Name | KATHRYN GOFORTH LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 6160 SHALLOWFORD RD STE 103
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7213
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Country | US
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Telephone | 423-892-2639
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Fax |
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Provider Business Mailing Address
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Address Line | 102 ROCKWOOD CIR SE
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City | HUNTSVILLE
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State | AL
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Zip | 35801-1811
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Country | US
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Telephone | 901-634-8181
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9100
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License Number State | TN
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