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General NPI Number Information
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NPI Number | 1902456841
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Entity Type | Individual
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Provider Name | COETTA MARKITA COLOMBEL MSW
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Gender | Female
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 3924 W ADAMS BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90018-1755
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Country | US
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Telephone | 239-980-6543
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Fax |
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Provider Business Mailing Address
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Address Line | 8821 AVIATION BLVD UNIT 88977
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City | LOS ANGELES
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State | CA
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Zip | 90009-3781
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Country | US
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Telephone | 424-577-0804
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 107201
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License Number State | CA
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