Provider Demographics
NPI:1497192199
Name:GOODENOUGH, WESLEY R (LICSW)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:R
Last Name:GOODENOUGH
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 HOOVER CT STE 218
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3618
Mailing Address - Country:US
Mailing Address - Phone:205-908-7447
Mailing Address - Fax:
Practice Address - Street 1:1957 HOOVER CT STE 218
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-3618
Practice Address - Country:US
Practice Address - Phone:205-908-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1502C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical