Individual
JESSE C COULTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
VET CENTER 521 CENTRAL AVE., CHARLESTON, WV 25302
(304) 343-3825
Mailing address
RR 4 BOX 153, CHARLESTON, WV 25312-9325
(304) 549-3891
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801081315
MI
Other
Enumeration date
01/30/2007
Last updated
07/08/2007
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