Provider Demographics
NPI:1356692388
Name:ABELSON-GOODE, JEANNETTE R (LCSW, CSOTP)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:R
Last Name:ABELSON-GOODE
Suffix:
Gender:F
Credentials:LCSW, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 N COURTHOUSE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4069
Mailing Address - Country:US
Mailing Address - Phone:804-794-4482
Mailing Address - Fax:804-379-7578
Practice Address - Street 1:703 N COURTHOUSE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4069
Practice Address - Country:US
Practice Address - Phone:804-794-4482
Practice Address - Fax:804-379-7578
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040053461041C0700X
VA08120004101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical