Provider Demographics
NPI:1326259508
Name:COCO, ANN C (MSW, LCSW, CMH)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:C
Last Name:COCO
Suffix:
Gender:F
Credentials:MSW, LCSW, CMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 AVERY ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3812
Mailing Address - Country:US
Mailing Address - Phone:404-373-5950
Mailing Address - Fax:
Practice Address - Street 1:1790 CENTURY BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3322
Practice Address - Country:US
Practice Address - Phone:404-931-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0017931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00697298AMedicaid
GAR13088Medicare UPIN
GA80BBCNQMedicare ID - Type Unspecified