Provider Demographics
NPI:1952936197
Name:GOODWYN, DANIELLE TAYLOR (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:TAYLOR
Last Name:GOODWYN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-5814
Mailing Address - Country:US
Mailing Address - Phone:804-690-8698
Mailing Address - Fax:
Practice Address - Street 1:2010 CARLISLE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-3445
Practice Address - Country:US
Practice Address - Phone:804-690-8698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040115241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical