Provider Demographics
NPI:1912207101
Name:GOODRICH, CARIN JEAN (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CARIN
Middle Name:JEAN
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:CARIN
Other - Middle Name:JEAN
Other - Last Name:LARDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:31815 SOUTHFIELD RD STE 18
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5471
Mailing Address - Country:US
Mailing Address - Phone:248-480-0115
Mailing Address - Fax:248-282-7114
Practice Address - Street 1:31815 SOUTHFIELD RD STE 18
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5471
Practice Address - Country:US
Practice Address - Phone:248-480-0115
Practice Address - Fax:248-282-7114
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007062101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid