Provider Demographics
NPI:1447432059
Name:GOODMAN, JULIE (LPC CAADC MAC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LPC CAADC MAC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC CAADC MAC
Mailing Address - Street 1:39425 GARFIELD RD STE 23
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4651
Mailing Address - Country:US
Mailing Address - Phone:586-213-2598
Mailing Address - Fax:
Practice Address - Street 1:39425 GARFIELD RD STE 23
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4651
Practice Address - Country:US
Practice Address - Phone:800-693-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010586101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor