Provider Demographics
NPI:1902954787
Name:GOLD, ROCHELLE ANIXT (MA, LMSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:ANIXT
Last Name:GOLD
Suffix:
Gender:F
Credentials:MA, LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N OLD WOODWARD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1322
Mailing Address - Country:US
Mailing Address - Phone:248-642-3101
Mailing Address - Fax:248-642-6832
Practice Address - Street 1:700 N OLD WOODWARD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1322
Practice Address - Country:US
Practice Address - Phone:248-642-3101
Practice Address - Fax:248-642-6832
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801017589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health