Provider Demographics
NPI:1205132784
Name:GOODKIN, CAROL ALICE (MA, RDT,LCAT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ALICE
Last Name:GOODKIN
Suffix:
Gender:F
Credentials:MA, RDT,LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 INDEPENDENCE BLVD STE D1
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-2151
Mailing Address - Country:US
Mailing Address - Phone:941-359-1927
Mailing Address - Fax:
Practice Address - Street 1:1748 INDEPENDENCE BLVD STE D1
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2151
Practice Address - Country:US
Practice Address - Phone:941-359-1927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health