Provider Demographics
NPI:1831428291
Name:GOODWIN, WILLIAM RUSSELL (LPC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 39TH AVENUE CT NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-9031
Mailing Address - Country:US
Mailing Address - Phone:434-258-7995
Mailing Address - Fax:
Practice Address - Street 1:2780 MORGANTON BLVD SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-8632
Practice Address - Country:US
Practice Address - Phone:434-258-7995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7619101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health