| Doctor Name: | MS. STEPHANIE ELAINE GOODWIN |
| NPI Number: | 1194053256 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, CSAC, QMHP |
| License Number: | 0710001130 |
| Business Practice Address: | 915 Lafayette Blvd # C Fredericksburg, VA - 224015667 |
| Business Phone Number: | 5406545113 |
| Business Fax Number: | 5406545859 |
| Mailing Address: | 3405 Pipit Dr, ALEXANDRIA |
| State: | VA |
| Postal Code: | 223062978 |
| Phone Number: | 7036093338 |
| Fax Number: | 5406545859 |
| NPI Enumeration Date: | 12/01/2009 |
| NPI Last Update Date: | 12/01/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 0710001130 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |