Provider Demographics
NPI:1639355225
Name:GOODWIN, DEVRA DAWN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEVRA
Middle Name:DAWN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 GOLD PASS HEIGHTS
Mailing Address - Street 2:MYRON STRATTON CAMPUS
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901
Mailing Address - Country:US
Mailing Address - Phone:719-689-3584
Mailing Address - Fax:719-689-5711
Practice Address - Street 1:435 GOLD PASS HTS
Practice Address - Street 2:MYRON STRATTON CAMPUS
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3882
Practice Address - Country:US
Practice Address - Phone:719-689-3584
Practice Address - Fax:719-689-5711
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical