Provider Demographics
NPI:1831778141
Name:GOODS, KATONIA HOWARD (LCSW-A)
Entity type:Individual
Prefix:
First Name:KATONIA
Middle Name:HOWARD
Last Name:GOODS
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N DAVIDSON ST APT 201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2984
Mailing Address - Country:US
Mailing Address - Phone:704-806-4568
Mailing Address - Fax:
Practice Address - Street 1:400 N DAVIDSON ST APT 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2984
Practice Address - Country:US
Practice Address - Phone:704-806-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP013112101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health