Individual
MRS. SARA GOBURDHUN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
14555 LEVAN RD, SUITE 401, LIVONIA, MI 48154-5083
(734) 953-0380
Mailing address
14555 LEVAN RD, SUITE 401, LIVONIA, MI 48154-5083
(734) 953-0380
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301006142
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6301006142
MI STATE LICENSE
MI
01
—
680H24703
BLUE CROSS BLUE SHIELD
MI
Enumeration date
12/08/2005
Last updated
07/08/2007
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