1194893206 NPI number — CHASITY LASHONDA GOODSON BSW

Table of content: CHASITY LASHONDA GOODSON BSW (NPI 1194893206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194893206 NPI number — CHASITY LASHONDA GOODSON BSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOODSON
Provider First Name:
CHASITY
Provider Middle Name:
LASHONDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194893206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 918
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENNETTSVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-454-0841
Provider Business Mailing Address Fax Number:
843-454-0635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1197 HAMLET HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENNETTSVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-454-0800
Provider Business Practice Location Address Fax Number:
843-454-0212
Provider Enumeration Date:
11/30/2006

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 405127 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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