Provider Demographics
NPI:1407868482
Name:GOODLING, RICHARD TAIT (MSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:TAIT
Last Name:GOODLING
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 FAULCONER DR
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4980
Mailing Address - Country:US
Mailing Address - Phone:434-963-0324
Mailing Address - Fax:
Practice Address - Street 1:501 FAULCONER DR
Practice Address - Street 2:SUITE 2D
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4980
Practice Address - Country:US
Practice Address - Phone:434-963-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040018161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA194810OtherANTHEM PROVIDER NETWORK