Healthcare Provider Details

I. General information

NPI: 1336795376
Provider Name (Legal Business Name): CARRIE GRAY COPPINI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 H ST
EUREKA CA
95501-4408
US

IV. Provider business mailing address

720 COPPINI LN
FERNDALE CA
95536-9624
US

V. Phone/Fax

Practice location:
  • Phone: 707-441-5220
  • Fax:
Mailing address:
  • Phone: 707-498-9641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC22483
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: