Provider Demographics
NPI:1386652139
Name:GOODRUM, L SMITH JR (PHD)
Entity Type:Individual
Prefix:
First Name:L
Middle Name:SMITH
Last Name:GOODRUM
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803
Mailing Address - Country:US
Mailing Address - Phone:828-274-1415
Mailing Address - Fax:828-274-9943
Practice Address - Street 1:932 HENDERSONVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-274-1415
Practice Address - Fax:828-274-9943
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1644103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6886164OtherVALUE OPTIONS
NC0366JOtherBCBS
NC0366JOtherBCBS