Provider Demographics
NPI: | 1679939656 |
---|---|
Name: | COATES, TEMITOPE SHAKIRAT (LCSW, LCADC) |
Entity Type: | Individual |
Prefix: | |
First Name: | TEMITOPE |
Middle Name: | SHAKIRAT |
Last Name: | COATES |
Suffix: | |
Gender: | F |
Credentials: | LCSW, LCADC |
Other - Prefix: | |
Other - First Name: | TEMITOPE |
Other - Middle Name: | SHAKIRAT |
Other - Last Name: | COATES |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | LCSW, LCADC, CCS |
Mailing Address - Street 1: | 654 MOUNT PROSPECT AVE STE 201 |
Mailing Address - Street 2: | |
Mailing Address - City: | NEWARK |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07104-3110 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 973-878-3900 |
Mailing Address - Fax: | 973-878-3809 |
Practice Address - Street 1: | 654 MOUNT PROSPECT AVE STE 201 |
Practice Address - Street 2: | |
Practice Address - City: | NEWARK |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07104-3110 |
Practice Address - Country: | US |
Practice Address - Phone: | 862-888-8146 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2016-01-06 |
Last Update Date: | 2019-07-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 37LC00242600 | 101YA0400X |
NJ | 44SC05667800 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |