Provider Demographics
NPI:1922252584
Name:GOLDSMITH, CONNIE JO (LCPC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:JO
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:JO
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:1520 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-2618
Mailing Address - Country:US
Mailing Address - Phone:618-664-1455
Mailing Address - Fax:618-664-1374
Practice Address - Street 1:1520 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-2618
Practice Address - Country:US
Practice Address - Phone:618-664-1455
Practice Address - Fax:618-664-1374
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.002482101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional