Provider Demographics
NPI:1811775125
Name:GOEBEL, MARY CLARK (MSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CLARK
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 MOUNT JACKSON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-8413
Mailing Address - Country:US
Mailing Address - Phone:304-320-1643
Mailing Address - Fax:
Practice Address - Street 1:130 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-2959
Practice Address - Country:US
Practice Address - Phone:681-339-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health