Provider Demographics
NPI:1497188072
Name:COFFMAN, LISA KAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:KAY
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:KAY
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610A OLD TAR VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-7936
Mailing Address - Country:US
Mailing Address - Phone:252-531-0472
Mailing Address - Fax:252-364-8971
Practice Address - Street 1:610A OLD TAR VILLAGE RD
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-7936
Practice Address - Country:US
Practice Address - Phone:252-531-0472
Practice Address - Fax:252-364-8971
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO91411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical