Provider Demographics
NPI:1356402135
Name:COFFEY, JAROD MATTHEW (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAROD
Middle Name:MATTHEW
Last Name:COFFEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3223
Mailing Address - Country:US
Mailing Address - Phone:828-337-0071
Mailing Address - Fax:828-350-1188
Practice Address - Street 1:417 BILTMORE AVE STE 2E
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4540
Practice Address - Country:US
Practice Address - Phone:828-350-1177
Practice Address - Fax:828-350-1188
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS 1549101YA0400X
NCLCSW C004949101YM0800X
NCC0049491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003407Medicaid
NC2870074Medicare ID - Type Unspecified