Individual
KIMBERLY LYNN GOODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, MRC, CRC, LPC
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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