Individual
DINA P GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
6301 19TH AVE NW, MINOT, ND 58703
(701) 858-0115
Mailing address
6301 19TH AVE NW, MINOT, ND 58703
(701) 858-0115
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1400
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26953
BLUE SHIELD OF ND
ND
05
—
75001
—
ND
Enumeration date
10/19/2006
Last updated
07/08/2007
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