MEDICARE: ROBIN L COULL MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C006702	NC

General Provider Information

NPI Number	:	1326365792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN L COULL MSW, LCSW

Provider Business Mailing Address
First Line	:	1016 IREDELL ST.
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7406 CHAPEL HILL ROAD
Second Line	:	SUITE F
City	:	RALEIGH
State	:	NC
Zip	:	27607
Country	:	US
Telephone Number	:	919-233-7360
Fax Number	:	919-233-7361

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	11/27/2013

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