Provider Demographics
NPI:1578797924
Name:COOLIDGE, JOHN KHRISTOPHER (LISW-CP, CAC I)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KHRISTOPHER
Last Name:COOLIDGE
Suffix:
Gender:M
Credentials:LISW-CP, CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:515 LAUREL HILL LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-1241
Mailing Address - Country:US
Mailing Address - Phone:803-929-0886
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF SOUTH CAROLINA
Practice Address - Street 2:COUNSELING & HUMAN DEVELOPMENT CENTER, BYRNES BLDG.
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-0001
Practice Address - Country:US
Practice Address - Phone:803-777-5223
Practice Address - Fax:803-777-5433
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC64071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical