Healthcare Provider Details

I. General information

NPI: 1821545260
Provider Name (Legal Business Name): AMBER LOREN COFFEY BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 CUMBERLAND FALLS HWY
CORBIN KY
40701-2729
US

IV. Provider business mailing address

PO BOX 568
CORBIN KY
40702-0568
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-8521
  • Fax: 606-523-8742
Mailing address:
  • Phone: 606-528-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number253107
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: