Provider Demographics
NPI:1699591941
Name:GOODMAN, ANDRE (LPC-A)
Entity type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 RUSTY MILL DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8020
Mailing Address - Country:US
Mailing Address - Phone:803-920-7278
Mailing Address - Fax:
Practice Address - Street 1:4116 RUSTY MILL DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8020
Practice Address - Country:US
Practice Address - Phone:803-920-7278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional