Provider Demographics
NPI:1043701568
Name:COFER, JODI (MA, LAPC)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:COFER
Suffix:
Gender:F
Credentials:MA, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 COWART RD
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-2723
Mailing Address - Country:US
Mailing Address - Phone:678-205-7577
Mailing Address - Fax:
Practice Address - Street 1:786 RIVERBEND RD
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-5530
Practice Address - Country:US
Practice Address - Phone:706-216-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006381101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty