Basic Information
| Provider Information | |||||||||
| NPI: | 1093958662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOCH | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC, CAADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 622 E GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488432329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5175480081 | ||||||||
| FaxNumber: | 5175480498 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 E GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488432329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5175480081 | ||||||||
| FaxNumber: | 5175480498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2009 | ||||||||
| LastUpdateDate: | 12/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | C-00067 | MI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 6401010491 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.