Healthcare Provider Details

I. General information

NPI: 1528793106
Provider Name (Legal Business Name): ANAISHA COATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E NORTHERN PKWY
BALTIMORE MD
21239-2113
US

IV. Provider business mailing address

1220 E JOPPA RD
TOWSON MD
21286-5811
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-7166
  • Fax:
Mailing address:
  • Phone: 410-499-4955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number35421
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: