Goodwin, Mary Petrina

Goodwin, Mary Petrina is an sole proprietor health care provider with primary practice located at 3825 Market St Ste 4 , Wilmington NC 28403-1426. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Goodwin, Mary Petrina can be contacted via phone (910) 777-5575.

Contact Information

Primary practice address
3825 Market St Ste 4 Wilmington NC 28403-1426
Phone: (910) 777-5575
Fax: (910) 777-5273
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X C010557 North Carolina
Behavioral Health & Social Service Providers / Clinical 1041C0700X C010557 North Carolina

Profile Details

NPI number 1124415302
LBN Legal business name Goodwin, Mary Petrina
Credentials LCSW, LCAS-A
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 24th, 2015
Last updated May 6th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124415302 NPPES
North Carolina MEDICAID 1124415302

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