Provider Demographics
NPI:1053457028
Name:GORIVODSKAYA, IZABELLA (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:IZABELLA
Middle Name:
Last Name:GORIVODSKAYA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1494 COMMERCE PINES DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:MI
Mailing Address - Zip Code:48390
Mailing Address - Country:US
Mailing Address - Phone:248-875-3661
Mailing Address - Fax:
Practice Address - Street 1:30500 NORTHWESTERN HWY
Practice Address - Street 2:316
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3178
Practice Address - Country:US
Practice Address - Phone:248-875-3661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085997101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health