Provider Demographics
NPI:1942884010
Name:GOLDEN, LACRESHA
Entity type:Individual
Prefix:
First Name:LACRESHA
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 E FAIRFIELD RD # 125
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-3688
Mailing Address - Country:US
Mailing Address - Phone:864-517-0490
Mailing Address - Fax:
Practice Address - Street 1:716 E FAIRFIELD RD # 125
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-3688
Practice Address - Country:US
Practice Address - Phone:864-517-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health