Provider Demographics
NPI:1386107506
Name:GODSIL, RICHARD WILLIAMS
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:WILLIAMS
Last Name:GODSIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SOUTHERN PECAN CIR UNIT 208
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6342
Mailing Address - Country:US
Mailing Address - Phone:970-261-3773
Mailing Address - Fax:
Practice Address - Street 1:1300 S DUNCAN DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4206
Practice Address - Country:US
Practice Address - Phone:352-343-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor