Provider Demographics
NPI:1407926991
Name:COAL, CAROL LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LEE
Last Name:COAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 G ST
Mailing Address - Street 2:STE. D
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501
Mailing Address - Country:US
Mailing Address - Phone:707-442-7806
Mailing Address - Fax:707-442-7806
Practice Address - Street 1:2830 G ST.
Practice Address - Street 2:STE. D
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-442-7806
Practice Address - Fax:707-442-7806
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS21833101YM0800X
CALSC218331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW218330OtherMEDI-CAL CROSS OVER
CA73-1707669OtherEIN
CACSW218330OtherMEDI-CAL CROSS OVER