MEDICARE: MRS. ELIZABETH ADETUTU COKER-NNAM M.A, NCC, LCPC

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	101YP2500X	Professional Counselor	LC3070	MD

General Provider Information

NPI Number	:	1497059448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ADETUTU COKER-NNAM M.A, NCC, LCPC

Provider Business Mailing Address
First Line	:	13806 CAPTAIN MARBURY LN
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-6128
Country	:	US
Telephone Number	:	301-793-8739
Fax Number	:

Provider Business Practice Location Address
First Line	:	6128 LANDOVER RD
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1016
Country	:	US
Telephone Number	:	301-793-8739
Fax Number	:

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

Provider Enumeration Date	:	01/05/2011
Last Update Date	:	01/05/2011

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