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General NPI Number Information
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NPI Number | 1861650996
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Entity Type | Organization
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Legal Business Name | TARA COPPOLA LCSW INC
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 370 PROSPECT PL
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City | ALPHARETTA
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State | GA
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Zip | 30005-5467
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Country | US
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Telephone | 678-488-1476
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Fax | 678-608-3827
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Provider Business Mailing Address
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Address Line | 3235 ENNFIELD LN
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City | DULUTH
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State | GA
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Zip | 30096-7721
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Country | US
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Telephone | 678-488-1476
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Fax | 678-608-3827
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Authorized Official
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Title or Position | PRINCIPAL
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Name | TARA COPPOLA
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Credential | LCSW
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Telephone | 678-488-1476
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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 | CSW003058
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License Number State | GA
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