Provider Demographics
NPI:1689869521
Name:GOODWIN, JAMES P (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:P
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 WHITINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6330
Mailing Address - Country:US
Mailing Address - Phone:301-622-2515
Mailing Address - Fax:301-622-2515
Practice Address - Street 1:509 WHITINGHAM DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6330
Practice Address - Country:US
Practice Address - Phone:301-622-2515
Practice Address - Fax:301-622-2515
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0846101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional