Provider Demographics
NPI:1003975905
Name:RAGEN-COFFMAN, DEBRA JEAN (MASTER OF ARTS)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:JEAN
Last Name:RAGEN-COFFMAN
Suffix:
Gender:F
Credentials:MASTER OF ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4809
Mailing Address - Country:US
Mailing Address - Phone:603-717-6256
Mailing Address - Fax:
Practice Address - Street 1:30 S MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4809
Practice Address - Country:US
Practice Address - Phone:603-717-6256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKLPA #A0279101YM0800X
NH847101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health