Healthcare Provider Details

I. General information

NPI: 1093958662
Provider Name (Legal Business Name): DONNA L. GOCH LPC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 E GRAND RIVER AVE
HOWELL MI
48843-2329
US

IV. Provider business mailing address

622 E GRAND RIVER AVE
HOWELL MI
48843-2329
US

V. Phone/Fax

Practice location:
  • Phone: 517-548-0081
  • Fax: 517-548-0498
Mailing address:
  • Phone: 517-548-0081
  • Fax: 517-548-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-00067
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401010491
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: