Healthcare Provider Details

I. General information

NPI: 1538978093
Provider Name (Legal Business Name): CLAUDIA COKER PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 RIDENOUR BLVD NW
KENNESAW GA
30152-4501
US

IV. Provider business mailing address

1300 RIDENOUR BLVD NW
KENNESAW GA
30152-4501
US

V. Phone/Fax

Practice location:
  • Phone: 240-855-6887
  • Fax:
Mailing address:
  • Phone: 678-951-9482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6171292
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6171292
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number8581511
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-4044811
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: