1043511488 NPI number — GERTRUDE WHITE GOODWIN LPC, ATR

Table of content: GERTRUDE WHITE GOODWIN LPC, ATR (NPI 1043511488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043511488 NPI number — GERTRUDE WHITE GOODWIN LPC, ATR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOODWIN
Provider First Name:
GERTRUDE
Provider Middle Name:
WHITE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, ATR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOODWIN
Provider Other First Name:
TRUDI
Provider Other Middle Name:
WHITE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, ATR
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1043511488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 N AUGUSTA ST
Provider Second Line Business Mailing Address:
PEOPLE PLACES, INC. STAUNTON
Provider Business Mailing Address City Name:
STAUNTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24401-3203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-885-8841
Provider Business Mailing Address Fax Number:
540-886-6379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 E JEFFERSON ST
Provider Second Line Business Practice Location Address:
PEOPLE PLACES, INC. CHARLOTTESVILLE
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22902-5328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-979-0335
Provider Business Practice Location Address Fax Number:
434-979-0202
Provider Enumeration Date:
11/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701004752 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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