| Organization Name: | MARIA C. COUGHENOUR LLC |
| NPI Number: | 1023381191 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMI SMITH (BUSINESS MANAGER) |
| Mailing Address: | 2318 Heron St Brunswick |
| State: | GA US |
| Postal Code: | 315204239 |
| Phone Number: | 9122657660 |
| Fax Number: | 9122657858 |
| NPI Enumeration Date: | 02/20/2012 |
| NPI Last Update Date: | 02/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LPC003217 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |