Doctor Name: | GREQUENCEO COGER |
NPI Number: | 1073924916 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.ED |
License Number: | |
Business Practice Address: | 1817 Saint Ives Xing Stockbridge, GA - 302819011 |
Business Phone Number: | 6783289571 |
Business Fax Number: | |
Mailing Address: | 1817 Saint Ives Xing, STOCKBRIDGE |
State: | GA |
Postal Code: | 302819011 |
Phone Number: | 6783289571 |
Fax Number: | |
NPI Enumeration Date: | 05/14/2014 |
NPI Last Update Date: | 05/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |