Coty Bourque, LCSW
NPI #1356850960 in Vicksburg, Mississippi
Provider Information
- NPI Number
- 1356850960
- Entity Type
- Individual
- Name
- Coty Bourque, LCSW
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Social Worker - Clinical
- Credential
- LCSW
- Enumeration Date
- Sep 26, 2017
- Last Updated
- May 13, 2025
Practice Location
- Address
- 1911 MISSION 66 STE B
- City
- Vicksburg
- State
- Mississippi
- ZIP Code
- 39180-3762
- Phone
- (337) 519-7797
Specialties & Taxonomy Codes
| Specialty |
|---|
| Social Worker - Clinical — Clinical |
| Counselor - Mental Health — Mental Health |
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