Provider Demographics
NPI:1265832877
Name:GOODING, AMELIE (LCMHC MLADC)
Entity Type:Individual
Prefix:
First Name:AMELIE
Middle Name:
Last Name:GOODING
Suffix:
Gender:F
Credentials:LCMHC MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ROXBURY ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3816
Mailing Address - Country:US
Mailing Address - Phone:603-358-4041
Mailing Address - Fax:603-358-6527
Practice Address - Street 1:106 ROXBURY ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3816
Practice Address - Country:US
Practice Address - Phone:603-358-4041
Practice Address - Fax:603-358-6527
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0592101YA0400X
NH326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)