MEDICARE: MRS. CAROLYN GOLDEN BS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		CA

General Provider Information

NPI Number	:	1770790206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN GOLDEN BS

Provider Business Mailing Address
First Line	:	1617 E SAGINAW WAY
Second Line	:	STE. #109
City	:	FRESNO
State	:	CA
Zip	:	93704-4458
Country	:	US
Telephone Number	:	559-241-0364
Fax Number	:	559-241-0342

Provider Business Practice Location Address
First Line	:	1617 E SAGINAW WAY
Second Line	:	STE. #109
City	:	FRESNO
State	:	CA
Zip	:	93704-4458
Country	:	US
Telephone Number	:	559-241-0364
Fax Number	:	559-241-0342

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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