Provider Demographics
NPI:1245879402
Name:THE GOODE DOCTOR LLC
Entity type:Organization
Organization Name:THE GOODE DOCTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODE-CTOSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:877-893-5480
Mailing Address - Street 1:602 SQUIRES RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2958
Mailing Address - Country:US
Mailing Address - Phone:443-438-4142
Mailing Address - Fax:
Practice Address - Street 1:920 PROVIDENCE RD STE 407
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2979
Practice Address - Country:US
Practice Address - Phone:877-893-5480
Practice Address - Fax:877-893-5480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1215203716OtherPSYCHOLOGY