Provider Demographics
NPI:1093217986
Name:GOODALL-MARTIN, CHERYL (LCDC III)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:GOODALL-MARTIN
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3018
Mailing Address - Country:US
Mailing Address - Phone:513-460-0874
Mailing Address - Fax:
Practice Address - Street 1:380 S PORTAGE PATH
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2326
Practice Address - Country:US
Practice Address - Phone:330-434-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH162069101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)