Provider Demographics
NPI:1881914620
Name:GOLDEN, ASHLI E (BS, LMT)
Entity type:Individual
Prefix:MISS
First Name:ASHLI
Middle Name:E
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:BS, LMT
Other - Prefix:MISS
Other - First Name:ASHLI
Other - Middle Name:
Other - Last Name:GOLDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS,LMT
Mailing Address - Street 1:1064 GARDNER RD
Mailing Address - Street 2:SUITE 313
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5768
Mailing Address - Country:US
Mailing Address - Phone:843-852-9939
Mailing Address - Fax:
Practice Address - Street 1:1064 GARDNER RD
Practice Address - Street 2:SUITE 313
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5768
Practice Address - Country:US
Practice Address - Phone:843-852-9939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20-4692852225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist