Provider Demographics
NPI:1477936300
Name:GOLDEN, GENA (LCSW, CHT)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:LCSW, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 SPRING CRK SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-2420
Mailing Address - Country:US
Mailing Address - Phone:404-333-2439
Mailing Address - Fax:404-220-8856
Practice Address - Street 1:2751 BUFORD HWY NE
Practice Address - Street 2:SUITE 700
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3207
Practice Address - Country:US
Practice Address - Phone:404-620-4439
Practice Address - Fax:404-220-8856
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0054671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical