Provider Demographics
NPI:1760683429
Name:GOODMAN, MARTHA MITCHELL (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:MITCHELL
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SUNSET AVE # A
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27921-9641
Mailing Address - Country:US
Mailing Address - Phone:252-336-2457
Mailing Address - Fax:
Practice Address - Street 1:111 SUNSET AVE # A
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NC
Practice Address - Zip Code:27921-9641
Practice Address - Country:US
Practice Address - Phone:252-336-2457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2262101Y00000X
NC39973101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool