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General NPI Number Information
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NPI Number | 1801048780
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Entity Type | Individual
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Provider Name | TERRI COALTER LCSW, BCD
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Gender | Female
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 4500 I 55 N SUITE 293
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City | JACKSON
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State | MS
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Zip | 39211-5930
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Country | US
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Telephone | 601-982-5943
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Fax |
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Provider Business Mailing Address
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Address Line | 25872 HIGHWAY 18
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City | UTICA
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State | MS
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Zip | 39175-9386
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Country | US
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Telephone | 601-946-5851
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C2641
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License Number State | MS
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