Provider Demographics
NPI:1124824552
Name:GOLDEN, JESSICA (APCC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W HALL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-2693
Mailing Address - Country:US
Mailing Address - Phone:619-902-2618
Mailing Address - Fax:
Practice Address - Street 1:114 W HALL AVE
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-2693
Practice Address - Country:US
Practice Address - Phone:619-902-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14758101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional