Individual
MARY E THEISEN-GOODVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
325 E EISENHOWER PKWY STE 300, ANN ARBOR, MI 48108-3439
(734) 936-7175
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301009981
MI
103TC0700X
Clinical Psychologist
Primary
6301009981
MI
Other
Enumeration date
11/14/2006
Last updated
02/28/2020
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