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General NPI Number Information
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NPI Number | 1609017433
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Entity Type | Individual
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Provider Name | BARRY KEVIN GODFREY LPC
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Gender | Male
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Dates
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Enumeration Date | 03/06/2009
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 1875 FANT DR
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-3307
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Country | US
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Telephone | 706-539-2228
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Fax | 706-539-1521
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Provider Business Mailing Address
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Address Line | 1875 FANT DR
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-3307
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Country | US
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Telephone | 706-861-3387
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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 | LPC006855
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License Number State | GA
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