Individual
MRS. MARY GOODNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
500 PARK AVE, LEBANON, TN 37087-3721
(615) 449-0500
Mailing address
2408 W CLAY DR, LEBANON, TN 37087-3168
(615) 444-2486
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4981
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4981
LICENSED CLINICAL SOCIAL WORKER LICENSE NUMBER
TN
Enumeration date
07/25/2008
Last updated
07/25/2008
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