MEDICARE: DR. KASSI LYNN GOODMAN 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	101YM0800X	Mental Health Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1255547949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KASSI LYNN GOODMAN LPC

Provider Business Mailing Address
First Line	:	1064 GARDNER RD STE 215
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-1712
Country	:	US
Telephone Number	:	843-779-7718
Fax Number	:	843-279-3161

Provider Business Practice Location Address
First Line	:	1064 GARDNER RD STE 215
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-1712
Country	:	US
Telephone Number	:	843-779-7718
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	01/13/2026

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