Provider Demographics
NPI:1902077142
Name:GOODWIN, SAMMIE JOCHUM (LPC, NCC, ATR-BC)
Entity Type:Individual
Prefix:MRS
First Name:SAMMIE
Middle Name:JOCHUM
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LPC, NCC, ATR-BC
Other - Prefix:MRS
Other - First Name:SAMMIE
Other - Middle Name:JOCHUM
Other - Last Name:REECE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATR
Mailing Address - Street 1:275 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-8300
Mailing Address - Country:US
Mailing Address - Phone:336-945-9026
Mailing Address - Fax:
Practice Address - Street 1:1401 W CLEMMONSVILLE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-5915
Practice Address - Country:US
Practice Address - Phone:336-771-4580
Practice Address - Fax:336-771-4706
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC 3124101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor