Provider Demographics
NPI:1629215439
Name:COPING CONCEPTS CLINICAL SERVICES INC.
Entity Type:Organization
Organization Name:COPING CONCEPTS CLINICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUCINTA
Authorized Official - Middle Name:VERNITA
Authorized Official - Last Name:ROME
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:423-718-1040
Mailing Address - Street 1:P.O. BOX 605
Mailing Address - Street 2:
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315
Mailing Address - Country:US
Mailing Address - Phone:423-718-1040
Mailing Address - Fax:
Practice Address - Street 1:5705 MARLIN ROAD
Practice Address - Street 2:SUITE 2001
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411
Practice Address - Country:US
Practice Address - Phone:413-718-1040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508685Medicaid