Healthcare Provider Details

I. General information

NPI: 1871158394
Provider Name (Legal Business Name): ERIN MARIE COPPEDGE NCC, LPC, CSOTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17579 WARWICK BLVD
NEWPORT NEWS VA
23603-1343
US

IV. Provider business mailing address

2704 WINDSOR SHADES LN
PROVIDENCE FORGE VA
23140-3601
US

V. Phone/Fax

Practice location:
  • Phone: 757-888-0400
  • Fax:
Mailing address:
  • Phone: 434-294-2372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0701008318
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: