Provider Demographics
NPI:1205543956
Name:GOODWIN, HANNAH (LCMHCA)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10105 HICKORYWOOD HILL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3421
Mailing Address - Country:US
Mailing Address - Phone:704-266-4208
Mailing Address - Fax:
Practice Address - Street 1:10105 HICKORYWOOD HILL AVE STE B
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3421
Practice Address - Country:US
Practice Address - Phone:704-266-4208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health