Provider Demographics
NPI:1730105834
Name:GOLDEN, BONNIE (LCSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 BRYNWOOD PL
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8989 COTSWOLD DR
Practice Address - Street 2:SUITE 8
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1601
Practice Address - Country:US
Practice Address - Phone:703-447-8389
Practice Address - Fax:703-391-1595
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040005411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA89-1726-4Medicaid
DCA5330001OtherCAREFIRST BCBS
VANF0561OtherEMPIRE BCBS
VA054050OtherANTHEM
VA512368OtherNCPPO
VA125335OtherVALUE OPTIONS
VA068541000OtherMAGELLAN
VA345176OtherUNITED HEALTH CARE
VA5675146OtherFIRST HEALTH
VANF0561OtherEMPIRE BCBS