Provider Demographics
NPI:1033486600
Name:GOLDEN, CHRISTINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:GOLDEN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1450 TROMBONE CT
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1644
Mailing Address - Country:US
Mailing Address - Phone:571-234-1057
Mailing Address - Fax:
Practice Address - Street 1:1483 CHAIN BRIDGE RD STE 301
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5703
Practice Address - Country:US
Practice Address - Phone:571-234-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6574103TC0700X
MD04996103TC2200X
VA0810004518103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical