Healthcare Provider Details

I. General information

NPI: 1487256111
Provider Name (Legal Business Name): VICTORIA COKER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 N SHIPP ST
HOBBS NM
88240-5725
US

IV. Provider business mailing address

PO BOX 1617
HOBBS NM
88241-1617
US

V. Phone/Fax

Practice location:
  • Phone: 575-964-2944
  • Fax:
Mailing address:
  • Phone: 575-964-2944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-11425
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: