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General NPI Number Information
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NPI Number | 1790651677
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Entity Type | Individual
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Provider Name | FAITH DIANA MARTIN- COULTER
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Gender | Female
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Dates
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Enumeration Date | 10/16/2025
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 3230 CALLIE LN
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-9591
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Country | US
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Telephone | 904-945-6205
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Fax | 888-498-7244
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Provider Business Mailing Address
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Address Line | 5460 COUNTY ROAD 352
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City | KEYSTONE HEIGHTS
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State | FL
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Zip | 32656-8265
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-482228
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License Number State | FL
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