Provider Demographics
NPI:1669606976
Name:GODDARD, ANDREA TERESE (LMHC, NCC)
Entity type:Individual
Prefix:PROF
First Name:ANDREA
Middle Name:TERESE
Last Name:GODDARD
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W 7TH AVE STE 260
Mailing Address - Street 2:ATTN: ANDREA
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2821
Mailing Address - Country:US
Mailing Address - Phone:509-220-9841
Mailing Address - Fax:509-624-1615
Practice Address - Street 1:707 W 7TH AVE STE 260
Practice Address - Street 2:ATTN: ANDREA
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2821
Practice Address - Country:US
Practice Address - Phone:509-220-9841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60040714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health