Provider Demographics
NPI:1184052953
Name:GOODWIN, TANYA NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:NICOLE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:GOODWIN
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, HSP-P
Mailing Address - Street 1:289 OLMSTED BLVD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:289 OLMSTED BLVD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8730
Practice Address - Country:US
Practice Address - Phone:910-295-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4762103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical