Provider Demographics
NPI:1518445964
Name:GOODWIN, TAMMIE RENEA SCHWEDLER (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:RENEA SCHWEDLER
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 39TH AVENUE CT NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-9031
Mailing Address - Country:US
Mailing Address - Phone:828-548-0623
Mailing Address - Fax:
Practice Address - Street 1:127 39TH AVENUE CT NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-9031
Practice Address - Country:US
Practice Address - Phone:828-548-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-29
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13984101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty