Provider Demographics
NPI:1760023600
Name:GOODNO, ANISSA FRANCES (LBSW)
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:FRANCES
Last Name:GOODNO
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:ANISSA
Other - Middle Name:FRANCES
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:2002 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:N MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-3120
Mailing Address - Country:US
Mailing Address - Phone:231-670-3463
Mailing Address - Fax:
Practice Address - Street 1:1145 WESLEY AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-2100
Practice Address - Country:US
Practice Address - Phone:231-670-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802078704104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker