Provider Demographics
NPI:1568602647
Name:CHARLES GOLODNER COUNNSELING GROUP
Entity Type:Organization
Organization Name:CHARLES GOLODNER COUNNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLODNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-349-2255
Mailing Address - Street 1:301 S MILLER ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5243
Mailing Address - Country:US
Mailing Address - Phone:805-349-2255
Mailing Address - Fax:805-739-0237
Practice Address - Street 1:601 E OCEAN AVE STE 14
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6929
Practice Address - Country:US
Practice Address - Phone:805-740-1144
Practice Address - Fax:805-740-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health