Provider Demographics
NPI:1912776410
Name:VIRGINIA L GOETSCH, PH.D.
Entity Type:Organization
Organization Name:VIRGINIA L GOETSCH, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOETSCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-301-3578
Mailing Address - Street 1:PO BOX 20032
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-8032
Mailing Address - Country:US
Mailing Address - Phone:770-301-3578
Mailing Address - Fax:866-753-2536
Practice Address - Street 1:197 RICE ML
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-5452
Practice Address - Country:US
Practice Address - Phone:770-301-3578
Practice Address - Fax:866-753-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty