Provider Demographics
NPI:1710057278
Name:GODETTE, MARILYN POWELL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:POWELL
Last Name:GODETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 984
Mailing Address - Street 2:2520 MURCHISON ROAD SUITE 7-A
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28302-0984
Mailing Address - Country:US
Mailing Address - Phone:910-580-0345
Mailing Address - Fax:910-488-7487
Practice Address - Street 1:2520 MURCHISON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3566
Practice Address - Country:US
Practice Address - Phone:910-580-0345
Practice Address - Fax:910-488-7487
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0017971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003385Medicaid