Provider Demographics
NPI:1316175946
Name:GOODMAN, TYRA LEI (LCSW, MSW)
Entity type:Individual
Prefix:
First Name:TYRA
Middle Name:LEI
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:TYRA
Other - Middle Name:LEI
Other - Last Name:GOODMAN-LEVINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, MSW
Mailing Address - Street 1:7 ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-0109
Mailing Address - Country:US
Mailing Address - Phone:828-450-8583
Mailing Address - Fax:
Practice Address - Street 1:573 FAIRVIEW RD STE 9
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1345
Practice Address - Country:US
Practice Address - Phone:828-504-8583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0044141041C0700X
NCCOO 64101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical