Provider Demographics
NPI:1457681876
Name:COFFEY, ANITA D (LCSW)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:D
Last Name:COFFEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:D
Other - Last Name:CARRENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-864-1472
Mailing Address - Fax:270-864-1693
Practice Address - Street 1:404 STEVE DR
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4622
Practice Address - Country:US
Practice Address - Phone:270-866-3161
Practice Address - Fax:270-866-3163
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5511104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid