Healthcare Provider Details

I. General information

NPI: 1609342575
Provider Name (Legal Business Name): GOLDEN LIFE COUNSELING AND COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 R ST NW STE 300
WASHINGTON DC
20009-6451
US

IV. Provider business mailing address

47 54TH ST SE
WASHINGTON DC
20019-6560
US

V. Phone/Fax

Practice location:
  • Phone: 202-779-1828
  • Fax:
Mailing address:
  • Phone: 860-916-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHENIKKA MOORE
Title or Position: OWNER
Credential: LICSW
Phone: 860-916-7400