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General NPI Number Information
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NPI Number | 1619556479
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Entity Type | Individual
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Provider Name | LISA MARIA GODO L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 44450 PINETREE DR STE 101
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City | PLYMOUTH
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State | MI
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Zip | 48170-3869
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Country | US
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Telephone | 734-738-0897
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Fax | 734-738-0898
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Provider Business Mailing Address
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Address Line | 2862 PAGE AVE
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City | ANN ARBOR
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State | MI
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Zip | 48104-6916
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Country | US
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Telephone | 734-272-6478
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401003103
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License Number State | MI
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