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General NPI Number Information
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NPI Number | 1396374435
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Entity Type | Individual
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Provider Name | HITASHIA NICHOLE GOODMON MS, BS, EIS
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Gender | Female
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 3427 NEW BOSTON RD
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City | TEXARKANA
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State | TX
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Zip | 75501-3137
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Country | US
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Telephone | 414-610-1426
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Fax |
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Provider Business Mailing Address
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Address Line | 1610 ROSEWOOD STREET
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City | TEXARKANA
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State | TX
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Zip | 75501
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Country | US
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Telephone | 414-610-1426
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | TX
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Taxonomy #2
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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 #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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