Provider Demographics
NPI:1508202797
Name:GOODE, DOMONIQUE JONES
Entity Type:Individual
Prefix:MS
First Name:DOMONIQUE
Middle Name:JONES
Last Name:GOODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-2123
Mailing Address - Country:US
Mailing Address - Phone:843-355-7233
Mailing Address - Fax:
Practice Address - Street 1:1503 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-2123
Practice Address - Country:US
Practice Address - Phone:843-355-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor