Individual
KIMBERLY LYNN GOODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, MRC, CRC, LPC
Contact information
Practice address
25490 LITTLE MACK AVE, SAINT CLAIR SHORES, MI 48081-2157
(586) 246-7837
Mailing address
25490 LITTLE MACK AVE, SAINT CLAIR SHORES, MI 48081-2157
(586) 246-7837
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401010236
MI
163WR0400X
Rehabilitation Registered Nurse
4704247001
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11861990
CAQH
—
Enumeration date
02/09/2015
Last updated
10/21/2016
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