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General NPI Number Information
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NPI Number | 1336283837
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Entity Type | Organization
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Legal Business Name | MARVIN D. COULTHARD
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 325 N MAIN ST
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City | TARBORO
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State | NC
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Zip | 27886-5009
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Country | US
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Telephone | 252-823-2927
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Fax | 252-823-8792
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Provider Business Mailing Address
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Address Line | 325 N MAIN ST
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City | TARBORO
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State | NC
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Zip | 27886-5009
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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 | ADMINISTRATOR
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Name | MR. MARVIN DAVID COULTHARD
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Credential | LPA
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Telephone | 252-823-2927
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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 | 1118
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4058
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0734
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | C000554
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4630
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License Number State | NC
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