Provider Demographics
NPI:1013750074
Name:GOODRICH, ALEXANDRA (LAC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 W INA RD STE 106
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3109
Mailing Address - Country:US
Mailing Address - Phone:843-964-0389
Mailing Address - Fax:
Practice Address - Street 1:1022 W INA RD STE 106
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3109
Practice Address - Country:US
Practice Address - Phone:843-964-0389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health