Active NPI
Marvin David Coulthard, M.A., L.P.A.
- Psychologist
- Tarboro, NC
National Provider Identifier
1548314180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 0734
- Practice address
- 325 N Main St
Tarboro, NC 27886-5009 - Phone
- (252) 823-2927
- Fax
- (252) 823-8792
- NPI assigned
- Jan 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 0734 | NC | Primary |
Addresses
Primary practice location
325 N Main St
Tarboro, NC 27886-5009
Mailing address
325 N Main St
Tarboro, NC 27886-5009
Phone (252) 823-2927
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6107021 | Medicaid | NC | |
| 046C6 | Other | NC | BLUECROSSBLUESHIELD |
| 52960 | Other | NC | CIGNABEHAVIORALHEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0734 | NC | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marvin D. Coulthard | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1548314180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 N MAIN ST",
"city": "TARBORO",
"state": "NC",
"postal_code": "278865009",
"telephone_number": "252-823-2927",
"fax_number": "252-823-8792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 N MAIN ST",
"city": "TARBORO",
"state": "NC",
"postal_code": "278865009",
"telephone_number": "252-823-2927",
"fax_number": "252-823-8792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COULTHARD",
"first_name": "MARVIN",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "M.A., L.P.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "0734",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6107021",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSSBLUESHIELD",
"identifier": "046C6",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNABEHAVIORALHEALTH",
"identifier": "52960",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tarboro, NC
- Community Home Care & Hospice, LLC
- Community Home Care & Hospice, LLC
- Community Home Care & Hospice, LLC
- Comprehensive Behavior Health Services, LLC
- Convenience Home Care Services
- County of Edgecombe Office of Auditor
- County of Edgecombe Office of Auditor
- County of Edgecombe Office of Auditor
- County of Edgecombe Office of Auditor
- County of Edgecombe Office of Auditor
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.