Provider Demographics
NPI:1508987231
Name:GOODING, LORI FOGUS (MM, MT-BC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:FOGUS
Last Name:GOODING
Suffix:
Gender:F
Credentials:MM, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 E HIGGINS DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-6889
Mailing Address - Country:US
Mailing Address - Phone:843-863-7782
Mailing Address - Fax:843-863-7042
Practice Address - Street 1:3505 E HIGGINS DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-6889
Practice Address - Country:US
Practice Address - Phone:843-863-7782
Practice Address - Fax:843-863-7042
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist