Healthcare Provider Details

I. General information

NPI: 1568602647
Provider Name (Legal Business Name): CHARLES GOLODNER COUNNSELING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E OCEAN AVE STE 14
LOMPOC CA
93436-6929
US

IV. Provider business mailing address

301 S MILLER ST STE 105
SANTA MARIA CA
93454-5243
US

V. Phone/Fax

Practice location:
  • Phone: 805-740-1144
  • Fax: 805-740-1144
Mailing address:
  • Phone: 805-349-2255
  • Fax: 805-739-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHARLES GOLODNER
Title or Position: OWNER
Credential:
Phone: 805-349-2255