Provider Demographics
NPI:1962789875
Name:CLAY, MICHELLE GOODWIN (LPC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:GOODWIN
Last Name:CLAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2712 MIDDLEBURG DR STE 207B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2445
Mailing Address - Country:US
Mailing Address - Phone:803-238-5063
Mailing Address - Fax:803-419-7497
Practice Address - Street 1:9023 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:SC
Practice Address - Zip Code:29061-9540
Practice Address - Country:US
Practice Address - Phone:803-978-1848
Practice Address - Fax:803-978-1852
Is Sole Proprietor?:No
Enumeration Date:2011-11-05
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1160Medicaid