Provider Demographics
NPI:1225232168
Name:GOINS, VERDALE (PHD, LPC, CACIII)
Entity Type:Individual
Prefix:DR
First Name:VERDALE
Middle Name:
Last Name:GOINS
Suffix:
Gender:M
Credentials:PHD, LPC, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 CORPORATE DR STE 209
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4050
Mailing Address - Country:US
Mailing Address - Phone:347-874-7105
Mailing Address - Fax:346-874-7106
Practice Address - Street 1:10701 CORPORATE DR STE 209
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477
Practice Address - Country:US
Practice Address - Phone:347-874-7105
Practice Address - Fax:346-874-7106
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1404101YP2500X
TX77413101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional