Provider Demographics
NPI:1437491578
Name:GOODING, BERNARD (LCPC)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:
Last Name:GOODING
Suffix:
Gender:M
Credentials:LCPC
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 6095
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20792-6095
Mailing Address - Country:US
Mailing Address - Phone:301-379-2619
Mailing Address - Fax:
Practice Address - Street 1:1113 IVY CLUB LN UNIT 742
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4521
Practice Address - Country:US
Practice Address - Phone:301-379-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1882101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional