Provider Demographics
NPI:1700189537
Name:GOETZ, CINDY SHARON (CDP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:SHARON
Last Name:GOETZ
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2213
Mailing Address - Country:US
Mailing Address - Phone:360-749-0258
Mailing Address - Fax:
Practice Address - Street 1:1055 9TH AVE STE D
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2661
Practice Address - Country:US
Practice Address - Phone:360-575-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002160101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)