Provider Demographics
NPI:1922725415
Name:ITS GOODEN GOOD LIFE COACHING AND COUNSELING
Entity Type:Organization
Organization Name:ITS GOODEN GOOD LIFE COACHING AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-809-5060
Mailing Address - Street 1:1045 ANDUIN FALLS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7004
Mailing Address - Country:US
Mailing Address - Phone:918-809-5060
Mailing Address - Fax:
Practice Address - Street 1:1045 ANDUIN FALLS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7004
Practice Address - Country:US
Practice Address - Phone:918-809-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)