Provider Demographics
NPI:1649334400
Name:GOLDEN, JUDITH LYNN (LCSW LMFT)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LYNN
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3856 HIGHGREEN DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068
Mailing Address - Country:US
Mailing Address - Phone:770-565-7284
Mailing Address - Fax:770-953-0807
Practice Address - Street 1:1501 JOHNSON FERRY RD SUITE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062
Practice Address - Country:US
Practice Address - Phone:770-955-8550
Practice Address - Fax:770-953-0807
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0001591041C0700X
GAMFT000438106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R12999Medicare UPIN
GA80BBBKGMedicare ID - Type Unspecified