Provider Demographics
NPI:1669212619
Name:GOODINE, CHARMICIELLE VENTERS (BCBA)
Entity type:Individual
Prefix:
First Name:CHARMICIELLE
Middle Name:VENTERS
Last Name:GOODINE
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:CHARMICIELLE
Other - Middle Name:
Other - Last Name:VENTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:308 LOURDES DR
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5130
Mailing Address - Country:US
Mailing Address - Phone:301-675-0883
Mailing Address - Fax:
Practice Address - Street 1:308 LOURDES DR
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5130
Practice Address - Country:US
Practice Address - Phone:301-675-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA1606103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst