Provider Demographics
NPI:1821584749
Name:GOLDEN, ZAKIRA IREE (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:ZAKIRA
Middle Name:IREE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3182 KINGS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-4837
Mailing Address - Country:US
Mailing Address - Phone:404-436-8043
Mailing Address - Fax:
Practice Address - Street 1:3760 LAVISTA RD STE 102
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5622
Practice Address - Country:US
Practice Address - Phone:678-626-0557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0-18-8739103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst