Provider Demographics
NPI:1760456230
Name:DEGOOD, DOUGLAS E (PHD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:DEGOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2332
Mailing Address - Country:US
Mailing Address - Phone:540-932-5747
Mailing Address - Fax:540-932-5748
Practice Address - Street 1:70 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 305
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-932-5747
Practice Address - Fax:540-932-5748
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001041103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7711018OtherVA PREMIER
VA1068499OtherFIRST HEALTH
VA25032OtherCIGNA
VA1046261OtherCIGNA BEHAVIORAL HEALTH
VA170228OtherSOUTHERN HEALTH
VA085256OtherSENTARA
VA284615OtherANTHEM
VA7711018OtherVA PREMIER