Provider Demographics
NPI:1720619679
Name:GOODWIN, JOHN WESLEY III (LCMHC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WESLEY
Last Name:GOODWIN
Suffix:III
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 STOWE DERBY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7377
Mailing Address - Country:US
Mailing Address - Phone:704-701-4463
Mailing Address - Fax:
Practice Address - Street 1:2015 AYRSLEY TOWN BLVD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4068
Practice Address - Country:US
Practice Address - Phone:704-412-1407
Practice Address - Fax:704-971-9192
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health