Individual
ANTOINETTE GOODEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, NCC, MAC, ACS
Contact information
Practice address
6000 STEWART PARKWAY, #6777, DOUGLASVILLE, GA 30135-6777
(404) 692-1014
(404) 393-1868
Mailing address
PO BOX 6777, DOUGLASVILLE, GA 30154-0030
(404) 692-1014
(404) 393-1868
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
MAC 508018
VA
101YM0800X
Mental Health Counselor
NCC 236587
NC
101YP2500X
Professional Counselor
Primary
LPC005074
GA
101YS0200X
School Counselor
SRS P12 683283
GA
3245S0500X
Children's Substance Abuse Rehabilitation Facility
508018
—
Other
Enumeration date
11/18/2007
Last updated
07/29/2019
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