Provider Demographics
NPI:1861926529
Name:COATSWORTH, WILLIAM JONAS (MA, LPC, LAC, CAC-II)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JONAS
Last Name:COATSWORTH
Suffix:
Gender:M
Credentials:MA, LPC, LAC, CAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 TEABERRY PATH
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-8104
Mailing Address - Country:US
Mailing Address - Phone:843-822-0073
Mailing Address - Fax:
Practice Address - Street 1:1437 TEABERRY PATH
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-8104
Practice Address - Country:US
Practice Address - Phone:843-822-0073
Practice Address - Fax:854-444-5210
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4984101YA0400X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility