Provider Demographics
NPI:1497059448
Name:COKER-NNAM, ELIZABETH ADETUTU (MA, NCC, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ADETUTU
Last Name:COKER-NNAM
Suffix:
Gender:F
Credentials:MA, NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13806 CAPTAIN MARBURY LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6128
Mailing Address - Country:US
Mailing Address - Phone:301-793-8739
Mailing Address - Fax:
Practice Address - Street 1:6128 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1016
Practice Address - Country:US
Practice Address - Phone:301-793-8739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional