Provider Demographics
NPI:1679168991
Name:GOODSON, STEPHEN (CERTIFIED COUNSELOR)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GOODSON
Suffix:
Gender:M
Credentials:CERTIFIED COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43367 16TH ST W APT 22
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3856
Mailing Address - Country:US
Mailing Address - Phone:661-471-5875
Mailing Address - Fax:
Practice Address - Street 1:43367 16TH ST W APT 22
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3856
Practice Address - Country:US
Practice Address - Phone:661-471-5875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI13441020101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)