Coty Bourque, LCSW Valid NPI

Individual provider · Clinical Social Worker · Vicksburg, MS

NPI

1356850960

Type

Individual (Type 1)

Primary specialty

Clinical Social Worker (Social Worker)

Specialty group

Behavioral Health & Social Service Providers

Taxonomy code

1041C0700X

Sex

Male

Sole proprietor

No

Enumerated

2017-09-26

Last updated

2025-05-13