Doctor Name: | TONI JACKSON-GOODE |
NPI Number: | 1184844292 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 7675 |
Business Practice Address: | 464 William Floyd Pkwy # 10 Shirley, NY - 119673468 |
Business Phone Number: | 6312881954 |
Business Fax Number: | 6312881955 |
Mailing Address: | 464 William Floyd Pkwy # 10, SHIRLEY |
State: | NY |
Postal Code: | 119673468 |
Phone Number: | 6312881954 |
Fax Number: | 6312881955 |
NPI Enumeration Date: | 04/30/2007 |
NPI Last Update Date: | 02/04/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 7675 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |