Provider Demographics
NPI:1255888368
Name:JOHNSON GOLDEN, AYEVA STAR (LPC, NCC)
Entity type:Individual
Prefix:
First Name:AYEVA
Middle Name:STAR
Last Name:JOHNSON GOLDEN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BOOKER ST
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-2627
Mailing Address - Country:US
Mailing Address - Phone:770-231-0508
Mailing Address - Fax:
Practice Address - Street 1:113 BOOKER ST
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-2627
Practice Address - Country:US
Practice Address - Phone:770-231-0508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional