Provider Demographics
NPI:1003491564
Name:GOODE, NICOLE SONNLEITNER
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:SONNLEITNER
Last Name:GOODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 WISCONSIN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3524
Mailing Address - Country:US
Mailing Address - Phone:588-830-1852
Mailing Address - Fax:
Practice Address - Street 1:3409A URBANA PIKE STE 2A
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7794
Practice Address - Country:US
Practice Address - Phone:443-788-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11227101YP2500X
MDLC13400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional