Provider Demographics
NPI:1679215206
Name:GOODE, FELEISHA (LCSW-A, CMSW)
Entity Type:Individual
Prefix:
First Name:FELEISHA
Middle Name:
Last Name:GOODE
Suffix:
Gender:F
Credentials:LCSW-A, CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9454 AVERY LILAC LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-6921
Mailing Address - Country:US
Mailing Address - Phone:980-277-4273
Mailing Address - Fax:
Practice Address - Street 1:8601 UNIVERSITY EAST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4353
Practice Address - Country:US
Practice Address - Phone:704-597-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0153661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical