Provider Demographics
NPI:1285832667
Name:GOODSON-JONES, STACIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:
Last Name:GOODSON-JONES
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 1:302 SCARLET OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-5389
Mailing Address - Country:US
Mailing Address - Phone:770-825-3514
Mailing Address - Fax:
Practice Address - Street 1:302 SCARLET OAKS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-5389
Practice Address - Country:US
Practice Address - Phone:770-825-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CSW0077601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker