Individual
EBONE COAKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1840 OLD NORCROSS RD, SUITE 200, LAWRENCEVILLE, GA 30044-8803
(770) 355-6073
(770) 913-8027
Mailing address
519 HARMONYVIEW CT, LOGANVILLE, GA 30052-6233
(770) 355-6073
(770) 913-8027
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW004856
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003168454B
—
GA
Enumeration date
09/22/2015
Last updated
08/31/2016
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