Courtney Nicole Goolsby

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701007081 Issued in VA

Practice address

5268 Godwin Blvd
Suffolk, VA 23434-8114

Phone

(757) 255-7117

Fax

(757) 255-7139

NPI assigned

Nov 27, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Courtney Nicole Goolsby Professional name

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Western Tidewater Community Mental

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Suffolk, VA
  • NPI 1689615296
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492041600000",
    "number": "1720419872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 WILDLIFE TRCE",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233207014",
            "telephone_number": "904-449-6185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5268 GODWIN BLVD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348114",
            "telephone_number": "757-255-7117",
            "fax_number": "757-255-7139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOOLSBY",
        "first_name": "COURTNEY",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-27",
        "last_updated": "2017-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701007081",
            "primary": true
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "GOOLSBY",
            "middle_name": "NICOLE",
            "credential": "LPC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Madeline Victoria Gonsalves
• Michael S Gonzalez, M.D.
• Patricia Goodman
• Shondesha Goodman
• Simone Goodwyn
• Asia Denise Gordon, NP
• Kayla Labre Gordon
• Erin Gossage, LPC
• Kraig S Graham, MD
• Kristen Leanna Graham, RBT

• Professional Counselor in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.