Basic Information
| Provider Information | |||||||||
| NPI: | 1205285475 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDEN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
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| Credential: | QASP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19707 HWY 280 E | ||||||||
| Address2: | APT 309 | ||||||||
| City: | SMITHS STATION | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368774031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565667892 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10175 FORTUNE PKWY | ||||||||
| Address2: | SUITE 903 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322566746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045380713 | ||||||||
| FaxNumber: | 9045380714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2016 | ||||||||
| LastUpdateDate: | 06/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.