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General NPI Number Information
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NPI Number | 1912776410
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Entity Type | Organization
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Legal Business Name | VIRGINIA L GOETSCH, PH.D.
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Dates
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Enumeration Date | 12/26/2023
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 197 RICE ML
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City | SAINT SIMONS ISLAND
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State | GA
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Zip | 31522-5452
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Country | US
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Telephone | 770-301-3578
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Fax | 866-753-2536
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Provider Business Mailing Address
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Address Line | PO BOX 20032
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City | SAINT SIMONS ISLAND
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State | GA
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Zip | 31522-8032
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Country | US
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Telephone | 770-301-3578
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Fax | 866-753-2536
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. VIRGINIA L GOETSCH
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Credential | PH.D.
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Telephone | 770-301-3578
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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 |
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License Number State |
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