Provider Demographics
NPI:1710693130
Name:GOLDEN, JASMINE PREANA
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:PREANA
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 BEAVER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8338
Mailing Address - Country:US
Mailing Address - Phone:706-315-2774
Mailing Address - Fax:
Practice Address - Street 1:3205 S CHEROKEE LN STE 130
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5402
Practice Address - Country:US
Practice Address - Phone:770-376-0906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist