Provider Demographics
NPI:1750031803
Name:COUTHEN, TINESHA CHEVON
Entity Type:Individual
Prefix:
First Name:TINESHA
Middle Name:CHEVON
Last Name:COUTHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5617 HARRINGTON VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-9140
Mailing Address - Country:US
Mailing Address - Phone:336-464-6212
Mailing Address - Fax:
Practice Address - Street 1:5617 HARRINGTON VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-9140
Practice Address - Country:US
Practice Address - Phone:336-464-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0148471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical