Provider Demographics
NPI:1952735557
Name:GOODENOUGH, ROGER C (LPC)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:C
Last Name:GOODENOUGH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24401 CAPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1343
Mailing Address - Country:US
Mailing Address - Phone:586-783-2950
Mailing Address - Fax:
Practice Address - Street 1:24401 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1343
Practice Address - Country:US
Practice Address - Phone:586-783-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002447101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health