Individual
MISS ELISE ASHLEY GOULBOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLPC
Contact information
Practice address
2995 E GRAND BLVD, DETROIT, MI 48202-3133
(313) 758-0150
(313) 758-0255
Mailing address
2995 E GRAND BLVD STE 1038, DETROIT, MI 48202-3133
(313) 758-0150
(313) 758-0255
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6451022680
MI
103TC1900X
Counseling Psychologist
6301015813
MI
Other
Enumeration date
01/24/2014
Last updated
08/01/2023
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