Provider Demographics
NPI:1770818320
Name:KERRI GOLDING, PA
Entity Type:Organization
Organization Name:KERRI GOLDING, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:GOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-849-6586
Mailing Address - Street 1:561 THORNTON RD
Mailing Address - Street 2:R
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-1558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:561 THORNTON RD
Practice Address - Street 2:R
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-1558
Practice Address - Country:US
Practice Address - Phone:404-849-6586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0031051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA103744492AMedicaid