Healthcare Provider Details

I. General information

NPI: 1801048780
Provider Name (Legal Business Name): TERRI COALTER LCSW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 I 55 N SUITE 293
JACKSON MS
39211-5930
US

IV. Provider business mailing address

25872 HIGHWAY 18
UTICA MS
39175-9386
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-5943
  • Fax:
Mailing address:
  • Phone: 601-946-5851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC2641
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: