Provider Demographics
NPI:1487919551
Name:COULTER DAVIS, CHRISTINE ADELE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ADELE
Last Name:COULTER DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:ADELE
Other - Last Name:COULTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1303 COTE SANS DESSEIN RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-1353
Mailing Address - Country:US
Mailing Address - Phone:707-318-5245
Mailing Address - Fax:
Practice Address - Street 1:800 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5275
Practice Address - Country:US
Practice Address - Phone:707-318-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MO20230467801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health