Individual
MR. MARVIN DAVID COULTHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., L.P.A.
Contact information
Practice address
325 N MAIN ST, TARBORO, NC 27886-5009
(252) 823-2927
(252) 823-8792
Mailing address
325 N MAIN ST, TARBORO, NC 27886-5009
(252) 823-2927
(252) 823-8792
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0734
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046C6
BLUECROSSBLUESHIELD
NC
01
—
52960
CIGNABEHAVIORALHEALTH
NC
05
—
6107021
—
NC
Enumeration date
01/22/2007
Last updated
07/08/2007
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