Provider Demographics
NPI:1164719845
Name:CARR, COY MARCUS (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:COY
Middle Name:MARCUS
Last Name:CARR
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2130
Mailing Address - Country:US
Mailing Address - Phone:415-820-5050
Mailing Address - Fax:415-820-5054
Practice Address - Street 1:4100 3RD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-2130
Practice Address - Country:US
Practice Address - Phone:415-820-5050
Practice Address - Fax:415-820-5054
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor