Provider Information for 1497122857
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ANDREA DAWN COULTER LCPC
Sex: Female
NPI: 1497122857
Last Updated: 2022-02-22
Certification Date: 2022-02-05
Certification Date: 2022-02-05
Details
| Name | Value | ||||||||
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| NPI | 1497122857 | ||||||||
| Enumeration Date | 2015-09-01 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4346 COUNCIL CIR JACKSON, MS 39206-5819 United States Phone: 618-534-0767 | Fax: | ||||||||
| Primary Practice Address | 1 REDBUD LN MURPHYSBORO, IL 62966-6551 United States Phone: 618-534-0767 | Fax: | ||||||||
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