Provider Demographics
NPI:1437468394
Name:GOOLSBY, BA'SHIRA (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:BA'SHIRA
Middle Name:
Last Name:GOOLSBY
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:PO BOX 431134
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48343-1134
Mailing Address - Country:US
Mailing Address - Phone:248-259-8973
Mailing Address - Fax:
Practice Address - Street 1:3984 COMMONWEALTH ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2574
Practice Address - Country:US
Practice Address - Phone:248-259-8973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010905401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical