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General NPI Number Information
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NPI Number | 1760934343
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Entity Type | Organization
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Legal Business Name | GOODWIN PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 11/03/2017
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Provider Practice Location Address
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Address Line | 34 W MAIN ST SUITE D
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City | HAMLET
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State | NC
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Zip | 28345-3636
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Country | US
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Telephone | 910-557-0044
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Fax | 910-716-9177
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Provider Business Mailing Address
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Address Line | PO BOX 1718
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City | HAMLET
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State | NC
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Zip | 28345-1718
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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 | OWNER/LICENSED PSYCHOLOGIST
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Name | DR. TANYA GOODWIN-BALDWIN
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Credential | HSP-P
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Telephone | 910-557-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 4762
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 4762
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4762
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License Number State | NC
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