Provider Demographics
NPI:1083800031
Name:JAMES, MARY COATES (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:COATES
Last Name:JAMES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JOSEPHINE
Other - Last Name:COATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:IVY
Mailing Address - State:VA
Mailing Address - Zip Code:22945-0641
Mailing Address - Country:US
Mailing Address - Phone:434-964-1910
Mailing Address - Fax:
Practice Address - Street 1:501 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5541
Practice Address - Country:US
Practice Address - Phone:434-964-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-23
Last Update Date:2007-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional