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General NPI Number Information
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NPI Number | 1508412750
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Entity Type | Individual
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Provider Name | ALYSSA MARINA-NICOLE GOODWINE LCMHC
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Gender | Female
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 405 KINGS CROSSING DR
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City | CHARLOTTE
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State | NC
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Zip | 28206-3870
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Country | US
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Telephone | 814-528-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8826
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 15027
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License Number State | NC
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