Provider Demographics
NPI:1225748734
Name:COFFEY, TIMEKA L (CDCA)
Entity Type:Individual
Prefix:
First Name:TIMEKA
Middle Name:L
Last Name:COFFEY
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7399
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-0399
Mailing Address - Country:US
Mailing Address - Phone:330-559-1760
Mailing Address - Fax:
Practice Address - Street 1:2304 MARTHA AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-3438
Practice Address - Country:US
Practice Address - Phone:234-237-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-25
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
OHCDCA.183757101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000000OtherNOT ISSUED YET