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General NPI Number Information
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NPI Number | 1144112665
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Entity Type | Organization
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Legal Business Name | GOLDEN GROVE BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 2561 PENDLETON RD
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City | MINERAL
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State | VA
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Zip | 23117-3914
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Country | US
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Telephone | 843-607-8689
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Fax |
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Provider Business Mailing Address
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Address Line | 2561 PENDLETON RD
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City | MINERAL
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State | VA
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Zip | 23117-3914
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Country | US
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Telephone | 843-607-8689
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR ANALYST/OWNER
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Name | BRITNEY DIANE CLARK
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Credential | BCBA, LBA
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Telephone | 843-607-8689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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