Healthcare Provider Details

I. General information

NPI: 1538648936
Provider Name (Legal Business Name): MR. KENNETH LASHAWN GOLDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5263 KORNWAL DR
COLUMBUS OH
43232-2816
US

IV. Provider business mailing address

5263 KORNWAL DR
COLUMBUS OH
43232-2816
US

V. Phone/Fax

Practice location:
  • Phone: 614-374-3578
  • Fax:
Mailing address:
  • Phone: 614-374-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: