Provider Demographics
NPI:1225268527
Name:GOLDEN, KATY RIDDLE
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:RIDDLE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATY
Other - Middle Name:LEIGH
Other - Last Name:RIDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 MALLARD ST.
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-4046
Mailing Address - Country:US
Mailing Address - Phone:864-241-1040
Mailing Address - Fax:864-241-1215
Practice Address - Street 1:124 MALLARD ST.
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-4046
Practice Address - Country:US
Practice Address - Phone:864-241-1040
Practice Address - Fax:864-241-1215
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC239317101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor