Individual
SHANISE GOODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFTA
Contact information
Practice address
521 CLANTON RD, CHARLOTTE, NC 28217-1369
(704) 755-0150
Mailing address
515 CLANTON RD, CHARLOTTE, NC 28217-1309
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
12404A
NC
Other
Enumeration date
02/25/2022
Last updated
02/25/2022
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