Provider Demographics
NPI:1881886661
Name:GOODSON-JOHNSON, MONIQUE S (LPC)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:S
Last Name:GOODSON-JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:SHEREEN
Other - Last Name:GOODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:616 HAY RIVER ST
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6209
Mailing Address - Country:US
Mailing Address - Phone:919-773-6148
Mailing Address - Fax:
Practice Address - Street 1:616 HAY RIVER ST
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529
Practice Address - Country:US
Practice Address - Phone:919-773-6148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional