Provider Demographics
NPI:1518069483
Name:GOFF, COLLEEN DIANE (LPC)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:DIANE
Last Name:GOFF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:DIANE
Other - Last Name:GOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1547 PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4081
Mailing Address - Country:US
Mailing Address - Phone:864-229-7120
Mailing Address - Fax:
Practice Address - Street 1:442 PROFESSIONAL PARK RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7626
Practice Address - Country:US
Practice Address - Phone:864-938-0912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4637101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC421504Medicaid
SC3340Medicare ID - Type Unspecified