Provider Demographics
NPI:1801260039
Name:GOODMAN-D'ANNA, HEATHER (MA, LPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GOODMAN-D'ANNA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 SUBURBIA DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5021
Mailing Address - Country:US
Mailing Address - Phone:318-450-5646
Mailing Address - Fax:
Practice Address - Street 1:520 OLIVE ST.
Practice Address - Street 2:SUITE B203
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2312
Practice Address - Country:US
Practice Address - Phone:318-963-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-27
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5685101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional