Provider Demographics
NPI:1215017942
Name:GODFREY, WILLIE MAE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:WILLIE
Middle Name:MAE
Last Name:GODFREY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 MARSH POINTE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7033
Mailing Address - Country:US
Mailing Address - Phone:803-834-7905
Mailing Address - Fax:
Practice Address - Street 1:538 MARSH POINTE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7033
Practice Address - Country:US
Practice Address - Phone:803-834-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health