Provider Demographics
NPI:1689034738
Name:COONS, AUDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:COONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 N ROCKY POINT DR W STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-7200
Mailing Address - Country:US
Mailing Address - Phone:813-773-5767
Mailing Address - Fax:813-658-6252
Practice Address - Street 1:3030 N ROCKY POINT DR W STE 150
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-7200
Practice Address - Country:US
Practice Address - Phone:813-773-5767
Practice Address - Fax:813-658-6252
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW134351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical