Provider Demographics
NPI:1619184058
Name:COOMBS, DONALD JR (CAGS, LADC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:COOMBS
Suffix:JR
Gender:M
Credentials:CAGS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01036-0245
Mailing Address - Country:US
Mailing Address - Phone:413-565-5121
Mailing Address - Fax:413-565-5121
Practice Address - Street 1:1200 CONVERSE ST
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1760
Practice Address - Country:US
Practice Address - Phone:413-565-5121
Practice Address - Fax:413-565-5121
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA537101YA0400X
CT000646101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)