Provider Demographics
NPI:1497486898
Name:COAXUM, SAMIA DENISE (MSW)
Entity type:Individual
Prefix:
First Name:SAMIA
Middle Name:DENISE
Last Name:COAXUM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 BROOKHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2099
Mailing Address - Country:US
Mailing Address - Phone:917-304-0489
Mailing Address - Fax:
Practice Address - Street 1:3915 BROOKHOLLOW DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2099
Practice Address - Country:US
Practice Address - Phone:917-304-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker