Individual
MR. KEVON JABARR GOODRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
46 RIDGE RD, HAMDEN, CT 06517-3506
(203) 752-8827
Mailing address
1812 HIDDEN SPRINGS WALK SE, SMYRNA, GA 30082-4254
(678) 444-4505
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT001607
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008042699
—
CT
Enumeration date
06/26/2009
Last updated
04/27/2024
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