Provider Demographics
NPI:1629410493
Name:GOLEM, ELIZABETH KATHRYN (LAC, DIPLAC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KATHRYN
Last Name:GOLEM
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W BROAD ST
Mailing Address - Street 2:SUITE #319
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3340
Mailing Address - Country:US
Mailing Address - Phone:703-209-5969
Mailing Address - Fax:
Practice Address - Street 1:450 W BROAD ST
Practice Address - Street 2:SUITE #319
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3340
Practice Address - Country:US
Practice Address - Phone:703-209-5969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000090171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist