Provider Demographics
NPI:1649036450
Name:COATES, KATARA JEANINE (LGPC)
Entity type:Individual
Prefix:
First Name:KATARA
Middle Name:JEANINE
Last Name:COATES
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 RISING LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3229
Mailing Address - Country:US
Mailing Address - Phone:443-223-4775
Mailing Address - Fax:
Practice Address - Street 1:170 JENNIFER RD STE 202
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7909
Practice Address - Country:US
Practice Address - Phone:443-291-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACII1250101YA0400X
MDLGP11779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)