MEDICARE: SASHA FARR-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	1041C0700X	Clinical Social Worker	16778	SC

General Provider Information

NPI Number	:	1730924952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SASHA FARR-GOODWIN

Provider Business Mailing Address
First Line	:	34 GAITED ACRES LN
Second Line	:
City	:	BLYTHEWOOD
State	:	SC
Zip	:	29016-5713
Country	:	US
Telephone Number	:	843-364-8096
Fax Number	:

Provider Business Practice Location Address
First Line	:	9153 TWO NOTCH RD STE C11
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5853
Country	:	US
Telephone Number	:	839-292-3902
Fax Number	:

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

Provider Enumeration Date	:	06/28/2024
Last Update Date	:	04/01/2026

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