Provider Demographics
NPI:1639244114
Name:GOODING, LAWRENCE A (MS & PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
Last Name:GOODING
Suffix:
Gender:M
Credentials:MS & PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 UNIVERSITY AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3643
Mailing Address - Country:US
Mailing Address - Phone:907-479-8545
Mailing Address - Fax:907-474-8165
Practice Address - Street 1:600 UNIVERSITY AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3643
Practice Address - Country:US
Practice Address - Phone:907-479-8545
Practice Address - Fax:907-474-8165
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK133101YP2500X, 385H00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child