Provider Demographics
NPI:1659701159
Name:GOODSON, HEATHER (LCMHC, LCAS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GOODSON
Suffix:
Gender:F
Credentials:LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 HIGHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1027
Mailing Address - Country:US
Mailing Address - Phone:919-714-7500
Mailing Address - Fax:
Practice Address - Street 1:3000 HIGHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1027
Practice Address - Country:US
Practice Address - Phone:919-714-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10060101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health