Provider Demographics
NPI:1558063719
Name:MCCOY, SALIMA (MSW)
Entity Type:Individual
Prefix:
First Name:SALIMA
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 SATELLITE BLVD APT 233
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2331
Mailing Address - Country:US
Mailing Address - Phone:706-202-4887
Mailing Address - Fax:
Practice Address - Street 1:3390 N BERKELEY LAKE RD NW STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3006
Practice Address - Country:US
Practice Address - Phone:470-327-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility