Provider Demographics
NPI:1053723973
Name:COFFMAN, CELESTE NACOLE (ALC)
Entity type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:NACOLE
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E MOBILE ST
Mailing Address - Street 2:SUITE 316
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-4782
Mailing Address - Country:US
Mailing Address - Phone:256-206-2032
Mailing Address - Fax:
Practice Address - Street 1:118 E MOBILE ST
Practice Address - Street 2:SUITE 316
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4782
Practice Address - Country:US
Practice Address - Phone:256-206-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2195A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor