Provider Demographics
NPI:1902000284
Name:CHARLES GOLODNER COUNSELING GROUP
Entity Type:Organization
Organization Name:CHARLES GOLODNER COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLODNER
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:805-349-2255
Mailing Address - Street 1:301 S MILLER ST
Mailing Address - Street 2:105
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5205
Mailing Address - Country:US
Mailing Address - Phone:805-349-2255
Mailing Address - Fax:805-739-0237
Practice Address - Street 1:301 S MILLER ST
Practice Address - Street 2:105
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5205
Practice Address - Country:US
Practice Address - Phone:805-349-2255
Practice Address - Fax:805-739-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29535103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty