Provider Demographics
NPI:1508980509
Name:GODWIN, ANTHONY M (MA, EDS, LPC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:GODWIN
Suffix:
Gender:M
Credentials:MA, EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PINE TREE CIR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2309
Mailing Address - Country:US
Mailing Address - Phone:828-337-4124
Mailing Address - Fax:
Practice Address - Street 1:12 PINE TREE CIR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2309
Practice Address - Country:US
Practice Address - Phone:828-337-4124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4638101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health