Provider Demographics
NPI:1487544847
Name:GOODMAN, THERESA (MA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14411 JUSTICE RD STE B
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6907
Mailing Address - Country:US
Mailing Address - Phone:434-962-9730
Mailing Address - Fax:
Practice Address - Street 1:14411 JUSTICE RD STE B
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6907
Practice Address - Country:US
Practice Address - Phone:434-962-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor