Provider Demographics
NPI:1831673110
Name:COOTS, NAKESHIA (CADC, ICADC)
Entity Type:Individual
Prefix:
First Name:NAKESHIA
Middle Name:
Last Name:COOTS
Suffix:
Gender:F
Credentials:CADC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 BROADWAY ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1465
Mailing Address - Country:US
Mailing Address - Phone:606-372-1400
Mailing Address - Fax:606-372-1404
Practice Address - Street 1:713 BROADWAY ST STE 103
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1465
Practice Address - Country:US
Practice Address - Phone:606-372-1400
Practice Address - Fax:606-372-1404
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270283101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)