Provider Demographics
NPI:1962488403
Name:GODIN, MARY MCLAIN (MA, LPA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MCLAIN
Last Name:GODIN
Suffix:
Gender:F
Credentials:MA, LPA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16581 US HWY 17 N
Mailing Address - Street 2:SUITE 600
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-7451
Mailing Address - Country:US
Mailing Address - Phone:910-270-9995
Mailing Address - Fax:910-270-9905
Practice Address - Street 1:16581 US HWY 17 N
Practice Address - Street 2:SUITE 600
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-7451
Practice Address - Country:US
Practice Address - Phone:910-270-9995
Practice Address - Fax:910-270-9905
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2335101YP2500X
NC4801-LPC103TC0700X
NC2335-LPA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107097Medicaid