Provider Demographics
NPI:1255583621
Name:GOODWIN, CHRISTY DENNY (GSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:DENNY
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:GSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 YOUREE DR
Mailing Address - Street 2:BLDG 1, SUITE 105
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3661
Mailing Address - Country:US
Mailing Address - Phone:318-861-1776
Mailing Address - Fax:318-868-1788
Practice Address - Street 1:2800 YOUREE DR
Practice Address - Street 2:BLDG 1, SUITE 105
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3661
Practice Address - Country:US
Practice Address - Phone:318-861-1776
Practice Address - Fax:318-868-1788
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8720104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker