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General NPI Number Information
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NPI Number | 1649629577
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Entity Type | Individual
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Provider Name | MICHELE PATRICE GODWIN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/10/2016
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Last Update Date | 06/10/2016
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Provider Practice Location Address
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Address Line | 100 N PITT ST SUITE 320
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3134
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Country | US
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Telephone | 703-249-5198
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Fax |
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Provider Business Mailing Address
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Address Line | 4551 STRUTFIELD LN APT. 4313
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City | ALEXANDRIA
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State | VA
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Zip | 22311-4967
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Country | US
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Telephone | 703-501-6101
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810003579
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY1000306
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License Number State | DC
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