Provider Demographics
NPI:1235620618
Name:GOODE, TIIU TOMIKA
Entity Type:Individual
Prefix:MS
First Name:TIIU
Middle Name:TOMIKA
Last Name:GOODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3643 WALTON WAY EXT BLDG 4
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6677
Mailing Address - Country:US
Mailing Address - Phone:803-671-2456
Mailing Address - Fax:
Practice Address - Street 1:3643 WALTON WAY EXT BLDG 4
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6677
Practice Address - Country:US
Practice Address - Phone:803-671-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor