Provider Demographics
NPI:1346643152
Name:GOODROE-MONETTE, NICOLE (MA , CRC, LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GOODROE-MONETTE
Suffix:
Gender:F
Credentials:MA , CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 DUNDEE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1289
Mailing Address - Country:US
Mailing Address - Phone:734-234-8550
Mailing Address - Fax:
Practice Address - Street 1:42207 ANN ARBOR RD E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170
Practice Address - Country:US
Practice Address - Phone:734-234-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014517101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional