Provider Demographics
NPI:1124745294
Name:GODBEY, MARY K (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:GODBEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 HALAPA WAY
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-7227
Mailing Address - Country:US
Mailing Address - Phone:217-572-2091
Mailing Address - Fax:
Practice Address - Street 1:1135 HALAPA WAY
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-7227
Practice Address - Country:US
Practice Address - Phone:217-572-2091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW148851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical