Provider Demographics
NPI:1265759609
Name:GODFREY, TAMMY (LCAS)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:GODFREY
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 SIGNAL HILL DRIVE EXT
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-4774
Mailing Address - Country:US
Mailing Address - Phone:704-871-2992
Mailing Address - Fax:704-871-2994
Practice Address - Street 1:636 SIGNAL HILL DRIVE EXT
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-4774
Practice Address - Country:US
Practice Address - Phone:704-871-2992
Practice Address - Fax:704-871-2994
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)