Provider Demographics
NPI:1164502811
Name:COUGHENOUR, MARIA C (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:C
Last Name:COUGHENOUR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SHOPPERS WAY STE 115
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0522
Mailing Address - Country:US
Mailing Address - Phone:912-265-7660
Mailing Address - Fax:912-265-7858
Practice Address - Street 1:106 SHOPPERS WAY STE 115
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-0522
Practice Address - Country:US
Practice Address - Phone:912-265-7660
Practice Address - Fax:912-265-7858
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3585103TC1900X
GA232032103TS0200X
GALPC003217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA691501868AMedicaid