Provider Demographics
NPI:1619506482
Name:GOODWIN, DARRIN L (APC)
Entity Type:Individual
Prefix:
First Name:DARRIN
Middle Name:L
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 PRIMROSE VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7155
Mailing Address - Country:US
Mailing Address - Phone:312-391-2209
Mailing Address - Fax:
Practice Address - Street 1:120 E TRINITY PL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3302
Practice Address - Country:US
Practice Address - Phone:404-378-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health