Provider Demographics
NPI:1255977385
Name:GOFMAN, DAVID (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GOFMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 MELROSE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-2716
Mailing Address - Country:US
Mailing Address - Phone:540-362-0360
Mailing Address - Fax:
Practice Address - Street 1:3716 MELROSE AVE NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-2716
Practice Address - Country:US
Practice Address - Phone:540-362-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3399101YM0800X
VA0701010835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health