Provider Demographics
NPI:1164584389
Name:GOLDSTEIN, VIRGINIA A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:A
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6039 ARMOR DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6267
Mailing Address - Country:US
Mailing Address - Phone:678-773-7596
Mailing Address - Fax:
Practice Address - Street 1:6039 ARMOR DR
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6267
Practice Address - Country:US
Practice Address - Phone:678-773-7596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA26641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical