Provider Demographics
NPI:1396434189
Name:LEE-COATES, JAZMA (CSC-AD)
Entity type:Individual
Prefix:
First Name:JAZMA
Middle Name:
Last Name:LEE-COATES
Suffix:
Gender:F
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 PULASKI HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-1315
Mailing Address - Country:US
Mailing Address - Phone:443-693-7596
Mailing Address - Fax:
Practice Address - Street 1:2719 PULASKI HWY STE 5
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-1315
Practice Address - Country:US
Practice Address - Phone:443-693-7596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC3137101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)