Provider Demographics
NPI:1902525041
Name:GOLDEN SHIELDS THERAPEUTIC & COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:GOLDEN SHIELDS THERAPEUTIC & COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-834-5033
Mailing Address - Street 1:2625 RUTLEDGE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2520
Mailing Address - Country:US
Mailing Address - Phone:803-834-5033
Mailing Address - Fax:
Practice Address - Street 1:2625 RUTLEDGE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2520
Practice Address - Country:US
Practice Address - Phone:803-834-5033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)