Provider Demographics
NPI:1154747616
Name:GODWIN, MICHELLE LYNN (LCSW85811)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LYNN
Last Name:GODWIN
Suffix:
Gender:F
Credentials:LCSW85811
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2004
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-2004
Mailing Address - Country:US
Mailing Address - Phone:530-691-2475
Mailing Address - Fax:
Practice Address - Street 1:5000 WINDPLAY DR STE 2
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9319
Practice Address - Country:US
Practice Address - Phone:530-903-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW778681041C0700X
CALCSW858111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical