Provider Demographics
NPI:1023550993
Name:COKER-BROWN, JALISSA
Entity Type:Individual
Prefix:
First Name:JALISSA
Middle Name:
Last Name:COKER-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 SPICER CV
Mailing Address - Street 2:#9
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-5623
Mailing Address - Country:US
Mailing Address - Phone:901-372-7878
Mailing Address - Fax:901-237-4961
Practice Address - Street 1:2165 SPICER CV
Practice Address - Street 2:#9
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-5623
Practice Address - Country:US
Practice Address - Phone:901-372-7878
Practice Address - Fax:901-237-4961
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)