Provider Demographics
NPI:1003513839
Name:GOODINE COUNSELING LTD
Entity Type:Organization
Organization Name:GOODINE COUNSELING LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOODINE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:920-660-9797
Mailing Address - Street 1:2123 NELLIE LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6068
Mailing Address - Country:US
Mailing Address - Phone:920-660-9797
Mailing Address - Fax:
Practice Address - Street 1:1050 CIRCLE DR STE B
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5569
Practice Address - Country:US
Practice Address - Phone:920-660-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100044216Medicaid