Organization
MHA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARLISSA Y GOODWIN (CARE PROVIDER)
(803) 735-9680
Entity
Organization
Contact information
Practice address
200 CLAUDE BUNDRICK RD, BLYTHEWOOD, SC 29016-9420
(803) 786-5478
Mailing address
419 TORWOOD DR, COLUMBIA, SC 29203
(803) 714-0948
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
101YM0800X
SC
Other
Enumeration date
11/20/2009
Last updated
11/20/2009
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