Provider Demographics
NPI:1508005554
Name:COULOMBE, WHITNEY ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:ANN
Last Name:COULOMBE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4066 SUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-5225
Mailing Address - Country:US
Mailing Address - Phone:901-531-1938
Mailing Address - Fax:
Practice Address - Street 1:4066 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-5225
Practice Address - Country:US
Practice Address - Phone:901-531-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4930OtherLCSW LICENSE NUMBER