Provider Demographics
NPI:1568842888
Name:COBURN, KRISTINE APRIL (MS)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:APRIL
Last Name:COBURN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:APRIL
Other - Last Name:SIMPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:6642 PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-5253
Mailing Address - Country:US
Mailing Address - Phone:251-625-6448
Mailing Address - Fax:
Practice Address - Street 1:6642 PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-5253
Practice Address - Country:US
Practice Address - Phone:251-625-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2206A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor