=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972831907
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOLANDA REDONA COATES LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2009
-----------------------------------------------------
Last Update Date | 01/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3810 BUFFINGTON PL
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30291-5027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-748-3762
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3810 BUFFINGTON PL
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30291-5027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-748-3762
-----------------------------------------------------
Fax | 470-428-6907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 7628
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------