Provider Demographics
NPI:1922650860
Name:GOODWIN, MARIAH (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 NILLES RD STE 5
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7205
Mailing Address - Country:US
Mailing Address - Phone:513-939-0300
Mailing Address - Fax:513-939-0310
Practice Address - Street 1:1251 NILLES RD STE 5
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7205
Practice Address - Country:US
Practice Address - Phone:513-939-0300
Practice Address - Fax:513-939-0310
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1902088101YP2500X
OHE.2102447101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional