MEDICARE: COLLEEN CHARISSE COOMBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C008810	NC

General Provider Information

NPI Number	:	1568138113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN CHARISSE COOMBS

Provider Business Mailing Address
First Line	:	1636 GOLD STAR DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-3371
Country	:	US
Telephone Number	:	984-664-6820
Fax Number	:

Provider Business Practice Location Address
First Line	:	1636 GOLD STAR DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-3371
Country	:	US
Telephone Number	:	984-664-6820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	08/23/2021

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Directions to “ COLLEEN CHARISSE COOMBS ” Practice Location

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