Provider Demographics
NPI:1144567348
Name:GOODIN, SARA M (MA, LPA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:GOODIN
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 S WILSON RD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-8944
Mailing Address - Country:US
Mailing Address - Phone:270-351-9444
Mailing Address - Fax:
Practice Address - Street 1:3909 S WILSON RD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-8944
Practice Address - Country:US
Practice Address - Phone:270-351-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1011103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist