Provider Information for 1023614864
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Dr. CAROLYN ANN GOOSBY DMin, MDiv, LCSW
Sex: Female
NPI: 1023614864
Last Updated: 2024-04-30
Certification Date: 2020-12-05
Certification Date: 2020-12-05
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1023614864 | ||||||||||||||||
| Enumeration Date | 2020-12-08 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | DR CAROLYN A GOOSBY 8108A CONCORD LANE JUSTICE, IL 60458 United States Phone: 773-507-3770 | Fax:708-563-0114 | ||||||||||||||||
| Primary Practice Address | 9701 S 49TH AVE OAK LAWN, IL 60453-3005 United States Phone: 773-507-3770 | Fax:708-563-0114 | ||||||||||||||||
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