Healthcare Provider Details

I. General information

NPI: 1316357247
Provider Name (Legal Business Name): CHARLOTTE COACHMAN BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8097 DECATUR ST
DETROIT MI
48228-2721
US

IV. Provider business mailing address

8097 DECATUR ST
DETROIT MI
48228-2721
US

V. Phone/Fax

Practice location:
  • Phone: 313-846-5020
  • Fax:
Mailing address:
  • Phone: 313-846-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: