MEDICARE: AYEVA STAR-JOHNSON GOLDEN LPC

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	101YP2500X	Professional Counselor	LPC008412	GA

General Provider Information

NPI Number	:	1255888368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYEVA STAR-JOHNSON GOLDEN LPC

Provider Business Mailing Address
First Line	:	113 BOOKER ST
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-2627
Country	:	US
Telephone Number	:	770-231-0508
Fax Number	:

Provider Business Practice Location Address
First Line	:	2052 WATSON BLVD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-3625
Country	:	US
Telephone Number	:	478-207-7773
Fax Number	:	877-299-6815

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	07/25/2025

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