Provider Demographics
NPI:1801293410
Name:GOODREAU, KRISTEN DAYLE (LCPC)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:DAYLE
Last Name:GOODREAU
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 COYLE RD
Mailing Address - Street 2:UNIT 407
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5094
Mailing Address - Country:US
Mailing Address - Phone:609-827-6091
Mailing Address - Fax:
Practice Address - Street 1:4800 COYLE RD
Practice Address - Street 2:UNIT 407
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5094
Practice Address - Country:US
Practice Address - Phone:609-827-6091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4828101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional