Active NPI
Gerald Evelyn Goodwin, LCSW
- Mental Health Counselor
- Falls Church, VA
National Provider Identifier
1306998349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 09043352
- Practice address
- 3531 Slade Run Dr
Falls Church, VA 22042-3923 - Phone
- (703) 237-2231
- Fax
- (703) 237-2231
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 09043352 | VA | Primary |
Addresses
Primary practice location
3531 Slade Run Dr
Falls Church, VA 22042-3923
Mailing address
3531 Slade Run Dr
Falls Church, VA 22042-3923
Phone (703) 237-2231
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8945616 | Medicaid | VA | |
| 394133 | Other | VA | UNITED MAMSI |
| 7745413 | Other | VA | AETNA |
| M607 | Other | VA | CARE FIRST |
Other names 1
- Mrs. Gerald Evelyn Dehaven
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09043352 | VA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1306998349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3531 SLADE RUN DR",
"city": "FALLS CHURCH",
"state": "VA",
"postal_code": "220423923",
"telephone_number": "703-237-2231",
"fax_number": "703-237-2231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3531 SLADE RUN DR",
"city": "FALLS CHURCH",
"state": "VA",
"postal_code": "220423923",
"telephone_number": "703-237-2231",
"fax_number": "703-237-2231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODWIN",
"first_name": "GERALD",
"middle_name": "EVELYN",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-18",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "VA",
"license": "09043352",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8945616",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED MAMSI",
"identifier": "394133",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7745413",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE FIRST",
"identifier": "M607",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "GERALD",
"last_name": "DEHAVEN",
"middle_name": "EVELYN",
"prefix": "MRS.",
"credential": "LCSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Falls Church, VA
- Goodwin House Home and Community Based Services
- Goodwin House Home and Community Based Services
- Goodwin House Incorporated
- Goodwin House Incorporated
- Goodwin House Incorporated
- Hannah Noor Khan Goodwin, MD
- Louise N Goodwin, MS, NCC
- Sanjiv Vikram Gopalkrishnan, MD
- Brandi Gordon
- Ziba Elizabeth Gorji, PHARMD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.