Provider Demographics
NPI:1528445111
Name:GOODINE, DEBORAH ANN (LPC-IT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:GOODINE
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 VERNON DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5374
Mailing Address - Country:US
Mailing Address - Phone:920-272-1200
Mailing Address - Fax:920-272-1201
Practice Address - Street 1:2680 VERNON DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5374
Practice Address - Country:US
Practice Address - Phone:920-272-1200
Practice Address - Fax:920-272-1201
Is Sole Proprietor?:No
Enumeration Date:2015-05-03
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2465-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional