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General NPI Number Information
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NPI Number | 1013780881
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Entity Type | Individual
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Provider Name | CONSTANCE COGGINS NACA II, CAC-AD BAS
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Gender | Female
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Dates
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Enumeration Date | 11/03/2023
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 1002 WASHINGTON AVE
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City | LA PLATA
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State | MD
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Zip | 20646-4228
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Country | US
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Telephone | 301-818-2812
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Fax |
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Provider Business Mailing Address
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Address Line | 8922 PENNS HILL RD
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City | LA PLATA
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State | MD
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Zip | 20646-4491
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | AC2471
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License Number State | MD
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