Provider Demographics
NPI:1154051605
Name:GOLDMAN, SARAH JANE WYNDHAM (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:SARAH JANE
Middle Name:WYNDHAM
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 BRIGHTON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-9649
Mailing Address - Country:US
Mailing Address - Phone:864-494-4222
Mailing Address - Fax:
Practice Address - Street 1:602 W POINSETT ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1448
Practice Address - Country:US
Practice Address - Phone:864-514-4792
Practice Address - Fax:864-448-1558
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9552101Y00000X, 101YM0800X, 101YS0200X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC2896Medicaid