Provider Demographics
NPI:1609198092
Name:COFFIN, ANDREW DEAN (CADC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DEAN
Last Name:COFFIN
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 D EAST WOODROW WILSON AVENUE
Mailing Address - Street 2:MAGNOLIA ADDICTION TREATMENT SERVICES
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4538
Mailing Address - Country:US
Mailing Address - Phone:601-896-0349
Mailing Address - Fax:601-362-3339
Practice Address - Street 1:500 D EAST WOODROW WILSON AVENUE
Practice Address - Street 2:MAGNOLIA ADDICTION TREATMENT SERVICES
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4538
Practice Address - Country:US
Practice Address - Phone:601-896-0349
Practice Address - Fax:601-362-3339
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)