Provider Demographics
NPI:1285036673
Name:GODEK, KRISTA (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:
Last Name:GODEK
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6065
Mailing Address - Country:US
Mailing Address - Phone:843-974-5934
Mailing Address - Fax:843-647-7768
Practice Address - Street 1:4 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6065
Practice Address - Country:US
Practice Address - Phone:843-974-5934
Practice Address - Fax:843-647-7768
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10103104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker