Provider Demographics
NPI:1477972909
Name:GOODWIN, CHANDRA LESHELL (MA, LPC-I)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:LESHELL
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MA, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 PERCIVAL RD
Mailing Address - Street 2:APT 621
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8363
Mailing Address - Country:US
Mailing Address - Phone:704-808-1833
Mailing Address - Fax:
Practice Address - Street 1:4021 PERCIVAL RD
Practice Address - Street 2:APT 621
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8363
Practice Address - Country:US
Practice Address - Phone:704-808-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5861101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health