MEDICARE: ANITA SCHAFER GODWIN M.S,, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC001808	GA

General Provider Information

NPI Number	:	1144266792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA SCHAFER GODWIN M.S,, LPC

Provider Business Mailing Address
First Line	:	631 CROWN POINT DR
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-9056
Country	:	US
Telephone Number	:	706-825-4731
Fax Number	:

Provider Business Practice Location Address
First Line	:	3633 WHEELER RD
Second Line	:	SUITE 110
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6549
Country	:	US
Telephone Number	:	706-855-7784
Fax Number	:	706-651-1090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/08/2007

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