Provider Demographics
NPI:1376602730
Name:GOODWIN, DONNA GAIL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:GAIL
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-0491
Mailing Address - Country:US
Mailing Address - Phone:808-492-6779
Mailing Address - Fax:808-888-0550
Practice Address - Street 1:66-590 KAMEHAMEHA HWY
Practice Address - Street 2:STE 2G
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1484
Practice Address - Country:US
Practice Address - Phone:808-471-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI965103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist