Provider Demographics
NPI:1629051248
Name:GOODSON, ANGELA CHARITY (LLP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:CHARITY
Last Name:GOODSON
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-1012
Mailing Address - Country:US
Mailing Address - Phone:269-657-5800
Mailing Address - Fax:269-657-8939
Practice Address - Street 1:304 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-1012
Practice Address - Country:US
Practice Address - Phone:269-657-5800
Practice Address - Fax:269-657-8939
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012552103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling