| Organization Name: | MARVIN D. COULTHARD |
| NPI Number: | 1336283837 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARVIN DAVID COULTHARD (ADMINISTRATOR) |
| Mailing Address: | 325 N Main St Tarboro |
| State: | NC US |
| Postal Code: | 278865009 |
| Phone Number: | 2528232927 |
| Fax Number: | 2528238792 |
| NPI Enumeration Date: | 02/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1118 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |