Provider Demographics
NPI:1164899258
Name:GOLUCH, CHERYL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:GOLUCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:LYNNE
Other - Last Name:GOLUCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 8459
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-8459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4250 34TH AVE W
Practice Address - Street 2:APT. 311
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199
Practice Address - Country:US
Practice Address - Phone:206-909-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW657491041C0700X
WALW000048361041C0700X
ORL73681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical