Provider Demographics
NPI:1295129088
Name:GOLD, HEATHER (LCSW119180)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:LCSW119180
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 MARKET ST STE 268
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1046
Mailing Address - Country:US
Mailing Address - Phone:530-605-3223
Mailing Address - Fax:
Practice Address - Street 1:13970 ELLS WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-8930
Practice Address - Country:US
Practice Address - Phone:530-605-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW366581041C0700X
CALCSW1191801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW1119180OtherBOARD OF BEHAVIORAL SCIENCES
CAASW36658OtherASW36658