Provider Demographics
NPI:1902596703
Name:GOLSTON-THOMAS, MARCUS TWAIN (APC009078)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:TWAIN
Last Name:GOLSTON-THOMAS
Suffix:
Gender:M
Credentials:APC009078
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CREEKSTONE RDG
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3746
Mailing Address - Country:US
Mailing Address - Phone:470-798-0202
Mailing Address - Fax:
Practice Address - Street 1:405 CREEKSTONE RDG
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3746
Practice Address - Country:US
Practice Address - Phone:470-798-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009078101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health