Provider Demographics
NPI:1871102186
Name:GOINS, STEPHANIE (PSYD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GOINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 SHEFWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3336
Mailing Address - Country:US
Mailing Address - Phone:864-397-0383
Mailing Address - Fax:
Practice Address - Street 1:704 SHEFWOOD DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3336
Practice Address - Country:US
Practice Address - Phone:864-397-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1611103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist