Organization
MARIA C. COUGHENOUR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMI SMITH (BUSINESS MANAGER)
(912) 265-7660
Entity
Organization
Contact information
Practice address
2318 HERON ST, BRUNSWICK, GA 31520-4239
(912) 265-7660
(912) 265-7858
Mailing address
2318 HERON ST, BRUNSWICK, GA 31520-4239
(912) 265-7660
(912) 265-7858
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC003217
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
691501868A
—
GA
Enumeration date
02/20/2012
Last updated
02/20/2012
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