Provider Demographics
NPI:1598241622
Name:COFFEE, DENISE (LPC, NCC, CCMHC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:COFFEE
Suffix:
Gender:F
Credentials:LPC, NCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 GEORGIA HIGHWAY 21 S STE 204
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5511
Mailing Address - Country:US
Mailing Address - Phone:912-633-9414
Mailing Address - Fax:
Practice Address - Street 1:5805 GEORGIA HIGHWAY 21 S STE 204
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5511
Practice Address - Country:US
Practice Address - Phone:912-633-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013337101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor