Provider Demographics
NPI:1063818060
Name:GOLDEN, AIESHA
Entity Type:Individual
Prefix:
First Name:AIESHA
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AIESHA
Other - Middle Name:
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5210 MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-2115
Mailing Address - Country:US
Mailing Address - Phone:608-807-7967
Mailing Address - Fax:
Practice Address - Street 1:5210 MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-2115
Practice Address - Country:US
Practice Address - Phone:608-807-7967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional