Provider Demographics
NPI:1841786050
Name:GOODWYN, RACHEL (LPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GOODWYN
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 1:4313 WILLIAM STYRON SQ N
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2874
Mailing Address - Country:US
Mailing Address - Phone:757-262-8466
Mailing Address - Fax:
Practice Address - Street 1:1 OLD OYSTER POINT RD STE 250
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-7149
Practice Address - Country:US
Practice Address - Phone:757-969-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional