Provider Demographics
NPI:1922475599
Name:COFFMAN, THEODORA P (PHD)
Entity Type:Individual
Prefix:DR
First Name:THEODORA
Middle Name:P
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 2ND ST N
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3328
Mailing Address - Country:US
Mailing Address - Phone:727-251-6874
Mailing Address - Fax:727-308-1185
Practice Address - Street 1:146 2ND ST N
Practice Address - Street 2:SUITE 310
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3328
Practice Address - Country:US
Practice Address - Phone:727-251-6874
Practice Address - Fax:727-308-1185
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-30
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9365103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist