Provider Demographics
NPI:1578568218
Name:GOLSTON, JOAN C (DCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:C
Last Name:GOLSTON
Suffix:
Gender:F
Credentials:DCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 E YESLER WAY
Mailing Address - Street 2:STE. 201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5516
Mailing Address - Country:US
Mailing Address - Phone:206-328-1366
Mailing Address - Fax:206-328-8510
Practice Address - Street 1:726 BROADWAY
Practice Address - Street 2:STE 303
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4337
Practice Address - Country:US
Practice Address - Phone:206-328-1366
Practice Address - Fax:206-328-8510
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-18
Last Update Date:2009-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000042241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical