Individual
LISA GOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLPC
Contact information
Practice address
13101 ALLEN RD, SOUTHGATE, MI 48195-2216
(734) 785-7700
Mailing address
30343 BERGHWAY TRL, WARREN, MI 48092-6331
(313) 283-5116
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401014567
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101Y00000X
PROFESSIONAL COUNSELOR
MI
01
—
101YM0800X
MENTAL HEALTH COUNSELOR
MI
Enumeration date
03/12/2017
Last updated
11/04/2021
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