Provider Demographics
NPI:1659929438
Name:GOOD, ALECIA NICOLE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:ALECIA
Middle Name:NICOLE
Last Name:GOOD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 DONNING DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-8063
Mailing Address - Country:US
Mailing Address - Phone:843-640-1504
Mailing Address - Fax:
Practice Address - Street 1:1114 ORANGEBURG RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-8904
Practice Address - Country:US
Practice Address - Phone:843-640-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer