Provider Demographics
NPI:1063661866
Name:GOODWIND, VIRGINIA (DOCTOR OF PSYCHOLOGY)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:
Last Name:GOODWIND
Suffix:
Gender:F
Credentials:DOCTOR OF PSYCHOLOGY
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94573-0396
Mailing Address - Country:US
Mailing Address - Phone:510-717-5703
Mailing Address - Fax:
Practice Address - Street 1:200 CALIFORNIA DRIVE
Practice Address - Street 2:HOLDERMAN HOSPITAL MEDICAL STAFF
Practice Address - City:YOUNTVILLE
Practice Address - State:CA
Practice Address - Zip Code:94599-1412
Practice Address - Country:US
Practice Address - Phone:510-717-5703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
106366186OtherNATIONAL PROFESSIONAL IDENTIFIER NUMBER