Provider Demographics
NPI:1225279904
Name:KATHALINA GONIEA MSW LMSW PC
Entity Type:Organization
Organization Name:KATHALINA GONIEA MSW LMSW PC
Other - Org Name:OAKTREE FAMILY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONIEA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW ACSW
Authorized Official - Phone:989-965-5200
Mailing Address - Street 1:2805 ASHMAN ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4408
Mailing Address - Country:US
Mailing Address - Phone:989-486-1373
Mailing Address - Fax:
Practice Address - Street 1:2805 ASHMAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4408
Practice Address - Country:US
Practice Address - Phone:989-486-1373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010725951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty