Provider Demographics
NPI:1245205467
Name:GOODIN, MARCHETA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARCHETA
Middle Name:
Last Name:GOODIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 SIDNEY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7203
Mailing Address - Country:US
Mailing Address - Phone:870-262-1357
Mailing Address - Fax:
Practice Address - Street 1:1215 SIDNEY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7203
Practice Address - Country:US
Practice Address - Phone:870-262-1357
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1062C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T122Medicare ID - Type Unspecified