Healthcare Provider Details

I. General information

NPI: 1356285704
Provider Name (Legal Business Name): COATES FREEDOM MINDED CONSULTING AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12538 MANOR RD
GLEN ARM MD
21057-9503
US

IV. Provider business mailing address

12538 MANOR RD
GLEN ARM MD
21057-9503
US

V. Phone/Fax

Practice location:
  • Phone: 443-742-0248
  • Fax:
Mailing address:
  • Phone: 443-742-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHUTIC COATES
Title or Position: PSYCHOTHERAPIST
Credential: LCSW-C
Phone: 443-742-0248