Provider Demographics
NPI:1962236364
Name:GOLEMON, RUSSELL H (MSW, LCAS-A)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:H
Last Name:GOLEMON
Suffix:
Gender:M
Credentials:MSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 COACHMANS TRL
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-9409
Mailing Address - Country:US
Mailing Address - Phone:601-329-6311
Mailing Address - Fax:
Practice Address - Street 1:108 COACHMANS TRL
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-9409
Practice Address - Country:US
Practice Address - Phone:601-329-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty