=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013552132
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALICIA COFFMAN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2019
-----------------------------------------------------
Last Update Date | 11/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1011 BROOKSIDE RD STE 302
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18106-9042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-809-9366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4211 MINSI ST
-----------------------------------------------------
City | SCHNECKSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18078-2616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALICIA COFFMAN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 484-954-7982
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------