MEDICARE: GINA GOODWIN

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	24115	CA

General Provider Information

NPI Number	:	1629931050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA GOODWIN

Provider Business Mailing Address
First Line	:	4228 N KAVANAGH AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-1244
Country	:	US
Telephone Number	:	559-491-6430
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 W CLINTON AVE
Second Line	:	SUITE 311
City	:	FRESNO
State	:	CA
Zip	:	93705
Country	:	US
Telephone Number	:	559-264-7521
Fax Number	:

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

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	03/12/2026

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Directions to “ GINA GOODWIN ” Practice Location

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