=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437491578
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BERNARD GOODING LCPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2013
-----------------------------------------------------
Last Update Date | 12/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1113 IVY CLUB LN UNIT 742
-----------------------------------------------------
City | LANDOVER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20785-4521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-379-2619
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6095
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20792-6095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-379-2619
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LC1882
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------