Provider Demographics
NPI:1720784366
Name:GOLLIN, CARLEIGH ANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLEIGH
Middle Name:ANNA
Last Name:GOLLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARLEIGH
Other - Middle Name:ANNA
Other - Last Name:ROWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3290 W BIG BEAVER RD STE 230
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2903
Mailing Address - Country:US
Mailing Address - Phone:248-238-8702
Mailing Address - Fax:
Practice Address - Street 1:3290 W BIG BEAVER RD STE 230
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-2903
Practice Address - Country:US
Practice Address - Phone:248-238-8702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851102831104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker