Provider Demographics
NPI:1780789578
Name:GOLISH, MARY ANN (B A)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:GOLISH
Suffix:
Gender:F
Credentials:B A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 584
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:MI
Mailing Address - Zip Code:48041-0584
Mailing Address - Country:US
Mailing Address - Phone:586-557-8299
Mailing Address - Fax:
Practice Address - Street 1:400 STODDARD ROAD
Practice Address - Street 2:MEMPHIS
Practice Address - City:MEMPHIS
Practice Address - State:MI
Practice Address - Zip Code:48041
Practice Address - Country:US
Practice Address - Phone:810-392-2167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor