Individual
DE'ANDREA COULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 E 5TH NORTH ST STE 120A, SUMMERVILLE, SC 29483-6822
(843) 460-2605
Mailing address
191 FAIRFAX BLVD, GOOSE CREEK, SC 29445-5731
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
SC
Other
Enumeration date
04/15/2022
Last updated
04/15/2022
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