Provider Demographics
NPI:1497268080
Name:COKER, DEBORAH HARRIS (EDS)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:HARRIS
Last Name:COKER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5054
Mailing Address - Country:US
Mailing Address - Phone:540-389-0130
Mailing Address - Fax:540-389-3638
Practice Address - Street 1:510 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5054
Practice Address - Country:US
Practice Address - Phone:540-389-0130
Practice Address - Fax:540-389-3638
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0813000122103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool