Provider Demographics
NPI:1669838348
Name:GOODMAN, MEREDITH PIERSON (M ED, LPC, LCMHC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:PIERSON
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:M ED, LPC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61298
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27661-1298
Mailing Address - Country:US
Mailing Address - Phone:843-742-4988
Mailing Address - Fax:843-353-3478
Practice Address - Street 1:1033 SHINE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1501
Practice Address - Country:US
Practice Address - Phone:843-742-4988
Practice Address - Fax:843-353-3478
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6486101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional