MEDICARE: CHARLES GOLODNER COUNSELING GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist	MFC29535	CA

General Provider Information

NPI Number	:	1902000284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES GOLODNER COUNSELING GROUP

Provider Business Mailing Address
First Line	:	301 S MILLER ST
Second Line	:	105
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-5205
Country	:	US
Telephone Number	:	805-349-2255
Fax Number	:	805-739-0237

Provider Business Practice Location Address
First Line	:	301 S MILLER ST
Second Line	:	105
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-5205
Country	:	US
Telephone Number	:	805-349-2255
Fax Number	:	805-739-0237

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. CHARLES GOLODNER
Credential	:	MFT
Telephone Number	:	805-349-2255

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	08/22/2020

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