Provider Demographics
NPI:1689734378
Name:GOLDEN, NICKIE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICKIE
Middle Name:L
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 HARDING AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3735
Mailing Address - Country:US
Mailing Address - Phone:808-389-6715
Mailing Address - Fax:808-732-5637
Practice Address - Street 1:3615 HARDING AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3735
Practice Address - Country:US
Practice Address - Phone:808-389-6715
Practice Address - Fax:808-732-5637
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY676103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist