Provider Demographics
NPI:1720741820
Name:GOINS, SUSAN RACHEL (SUPPORT COORDINATOR)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:RACHEL
Last Name:GOINS
Suffix:
Gender:F
Credentials:SUPPORT COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 COCONUT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4201
Mailing Address - Country:US
Mailing Address - Phone:239-362-5802
Mailing Address - Fax:239-288-2499
Practice Address - Street 1:961 COCONUT DR
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4201
Practice Address - Country:US
Practice Address - Phone:239-362-5802
Practice Address - Fax:239-288-2499
Is Sole Proprietor?:No
Enumeration Date:2021-10-16
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL017672800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker