Provider Demographics
NPI:1568255834
Name:GOODNER, CHANERIA BRETCHET
Entity type:Individual
Prefix:
First Name:CHANERIA
Middle Name:BRETCHET
Last Name:GOODNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 ARLENE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-2340
Mailing Address - Country:US
Mailing Address - Phone:937-818-7656
Mailing Address - Fax:
Practice Address - Street 1:1415 SALEM AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-4941
Practice Address - Country:US
Practice Address - Phone:937-818-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional