Provider Demographics
NPI:1053888156
Name:GOODWIN, CHERYL ABEL (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ABEL
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:GOODWIN PC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:3292 GREEN OAK DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-1614
Mailing Address - Country:US
Mailing Address - Phone:248-892-2403
Mailing Address - Fax:248-626-1551
Practice Address - Street 1:6960 ORCHARD LAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4523
Practice Address - Country:US
Practice Address - Phone:248-626-1500
Practice Address - Fax:248-626-1551
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010190291041C0700X
MI680101990291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty