Provider Demographics
NPI:1376301804
Name:OPAL GOODWIN, LCSW, LLC
Entity Type:Organization
Organization Name:OPAL GOODWIN, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OPAL
Authorized Official - Middle Name:CELESTE
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-955-2770
Mailing Address - Street 1:38261 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3905
Mailing Address - Country:US
Mailing Address - Phone:225-955-2770
Mailing Address - Fax:
Practice Address - Street 1:38261 BROWN RD
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3905
Practice Address - Country:US
Practice Address - Phone:225-955-2770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty