Provider Demographics
NPI:1235961822
Name:COKER, CICELY
Entity type:Individual
Prefix:
First Name:CICELY
Middle Name:
Last Name:COKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18101 E WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1382
Mailing Address - Country:US
Mailing Address - Phone:810-973-5012
Mailing Address - Fax:800-205-9989
Practice Address - Street 1:18101 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1382
Practice Address - Country:US
Practice Address - Phone:810-973-5012
Practice Address - Fax:800-205-9989
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician