Provider Demographics
NPI:1093420952
Name:COFFMAN, KARISSA CHRISTINE (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:KARISSA
Middle Name:CHRISTINE
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 HEISS RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-9419
Mailing Address - Country:US
Mailing Address - Phone:734-652-3387
Mailing Address - Fax:
Practice Address - Street 1:717 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2929
Practice Address - Country:US
Practice Address - Phone:734-258-3518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511156441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical