MEDICARE: MS. DONNA CECILIA COAKLEY 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	101YM0800X	Mental Health Counselor	LC0875	MD
2	101YM0800X	Mental Health Counselor	PRC1370	DC

General Provider Information

NPI Number	:	1780822148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA CECILIA COAKLEY LCPC

Provider Business Mailing Address
First Line	:	77 H ST NW APT 151
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20001-2336
Country	:	US
Telephone Number	:	301-908-9236
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 MICHIGAN AVE NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-1095
Country	:	US
Telephone Number	:	202-877-7943
Fax Number	:	855-778-6874

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

Provider Enumeration Date	:	01/22/2009
Last Update Date	:	04/23/2021

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