Provider Demographics
NPI:1457536047
Name:COFFEY, WILLIAM ANDREW (LMSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ANDREW
Last Name:COFFEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3741 WILDER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2343
Mailing Address - Country:US
Mailing Address - Phone:989-460-1000
Mailing Address - Fax:989-460-1001
Practice Address - Street 1:467 N STATE ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1539
Practice Address - Country:US
Practice Address - Phone:989-672-6160
Practice Address - Fax:989-672-6272
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801079141104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7509134480OtherBCBS
MI7509134480OtherBCBS