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NPI Code Detail

MEDICARE: AMANDA LOUSIE GODDARD LLMSW

MEDICARE: AMANDA LOUSIE GODDARD LLMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor6851120343MI

General Provider Information

NPI Number : 1356292783
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA LOUSIE GODDARD LLMSW
Provider Business Mailing Address
First Line : 4925 PACKARD ST
Second Line :
City : ANN ARBOR
State : MI
Zip : 48108-1521
Country : US
Telephone Number : 734-971-9781
Fax Number : 734-971-2730
Provider Business Practice Location Address
First Line : 4925 PACKARD ST
Second Line :
City : ANN ARBOR
State : MI
Zip : 48108-1521
Country : US
Telephone Number : 734-971-9781
Fax Number : 734-971-2730
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2026
Last Update Date : 02/03/2026

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