Provider Demographics
NPI:1538773395
Name:COFFIE, KESHIA LATOYA (MPA, MSW)
Entity type:Individual
Prefix:
First Name:KESHIA
Middle Name:LATOYA
Last Name:COFFIE
Suffix:
Gender:F
Credentials:MPA, MSW
Other - Prefix:
Other - First Name:KESHIA
Other - Middle Name:LATOYA
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1833 HALSTEAD BLVD APT 407
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3472
Mailing Address - Country:US
Mailing Address - Phone:813-952-4249
Mailing Address - Fax:
Practice Address - Street 1:1833 HALSTEAD BLVD APT 407
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3472
Practice Address - Country:US
Practice Address - Phone:813-952-4249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC100512826390OtherDRIVER'S LICENSE