Provider Demographics
NPI:1912108275
Name:RAGSDALE-COFFMAN, LISA A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:RAGSDALE-COFFMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5114
Mailing Address - Country:US
Mailing Address - Phone:530-878-0126
Mailing Address - Fax:
Practice Address - Street 1:144 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5114
Practice Address - Country:US
Practice Address - Phone:530-878-0126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS-172331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA360392OtherMHN
CA9958OtherPLACER COUNTY MENTAL HEA