Provider Demographics
NPI:1659084267
Name:COULTER, CHARLOTTE ANITA (PHD (HONARARY))
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:ANITA
Last Name:COULTER
Suffix:
Gender:F
Credentials:PHD (HONARARY)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 GENTIAN BLVD STE 8A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5639
Mailing Address - Country:US
Mailing Address - Phone:706-530-8756
Mailing Address - Fax:470-552-2767
Practice Address - Street 1:3100 GENTIAN BLVD STE 8A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5639
Practice Address - Country:US
Practice Address - Phone:706-530-8756
Practice Address - Fax:470-552-2767
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003251476AMedicaid