Healthcare Provider Details

I. General information

NPI: 1497268080
Provider Name (Legal Business Name): DEBORAH HARRIS COKER ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S COLLEGE AVE
SALEM VA
24153-5054
US

IV. Provider business mailing address

510 S COLLEGE AVE
SALEM VA
24153-5054
US

V. Phone/Fax

Practice location:
  • Phone: 540-389-0130
  • Fax: 540-389-3638
Mailing address:
  • Phone: 540-389-0130
  • Fax: 540-389-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0813000122
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: