MEDICARE: DR. DOVEAL GOINS PSYD

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	103TF0200X	Forensic Psychologist
2	103TF0200X	Forensic Psychologist	06378	MD
3	103TC0700X	Clinical Psychologist	06378	MD

General Provider Information

NPI Number	:	1518274588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOVEAL GOINS PSYD

Provider Business Mailing Address
First Line	:	16701 MELFORD BLVD
Second Line	:	STE 400
City	:	BOWIE
State	:	MD
Zip	:	20715-4411
Country	:	US
Telephone Number	:	443-900-9957
Fax Number	:

Provider Business Practice Location Address
First Line	:	16701 MELFORD BLVD
Second Line	:	STE 400
City	:	BOWIE
State	:	MD
Zip	:	20715-4411
Country	:	US
Telephone Number	:	443-900-9957
Fax Number	:

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

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	07/20/2022

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