Healthcare Provider Details

I. General information

NPI: 1811659568
Provider Name (Legal Business Name): ANGELA M GOODMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. ANGELA M GOODMAN

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2399 E WALTON BLVD
AUBURN HILLS MI
48326-1955
US

IV. Provider business mailing address

45511 REVERE DR
SHELBY TOWNSHIP MI
48315-6079
US

V. Phone/Fax

Practice location:
  • Phone: 248-475-6400
  • Fax: 248-475-6403
Mailing address:
  • Phone: 313-629-0193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number23178090639
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: