Provider Demographics
NPI:1790412773
Name:COHEN, THELMA LATRICE
Entity Type:Individual
Prefix:MRS
First Name:THELMA
Middle Name:LATRICE
Last Name:COHEN
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 1:3265 COHEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-7200
Mailing Address - Country:US
Mailing Address - Phone:843-200-8475
Mailing Address - Fax:843-559-2149
Practice Address - Street 1:3265 COHEN HILL RD
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-7200
Practice Address - Country:US
Practice Address - Phone:843-200-8475
Practice Address - Fax:843-559-2149
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC008816466172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver