Healthcare Provider Details

I. General information

NPI: 1396434189
Provider Name (Legal Business Name): JAZMA LEE-COATES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 PULASKI HWY STE 5
EDGEWOOD MD
21040-1315
US

IV. Provider business mailing address

2719 PULASKI HWY STE 5
EDGEWOOD MD
21040-1315
US

V. Phone/Fax

Practice location:
  • Phone: 443-693-7596
  • Fax:
Mailing address:
  • Phone: 410-676-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34807
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSC3137
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34807
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: