Provider Demographics
NPI:1053160226
Name:GOODS, NALICIA
Entity type:Individual
Prefix:
First Name:NALICIA
Middle Name:
Last Name:GOODS
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 1:8601 SIDE SADDLE CT
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-5344
Mailing Address - Country:US
Mailing Address - Phone:410-419-2969
Mailing Address - Fax:
Practice Address - Street 1:8601 SIDE SADDLE CT
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5344
Practice Address - Country:US
Practice Address - Phone:410-419-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17085104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker