Basic Information
| Provider Information | |||||||||
| NPI: | 1538694559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDEN | ||||||||
| FirstName: | JEANNIE | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 RAWL BUILDING | ||||||||
| Address2: | DEPARTMENT OF PSYCHOLOGY EAST CAROLINA UNIVERSITY | ||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523286206 | ||||||||
| FaxNumber: | 2523286283 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 RAWL BUILDING | ||||||||
| Address2: | DEPARTMENT OF PSYCHOLOGY EAST CAROLINA UNIVERSITY | ||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523286206 | ||||||||
| FaxNumber: | 2523286283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2017 | ||||||||
| LastUpdateDate: | 04/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 1262 | NC | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.