Provider Demographics
NPI:1033349543
Name:COLEMAN, RODERICK EUGENE (LADC)
Entity Type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:EUGENE
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2401 96TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1148
Mailing Address - Country:US
Mailing Address - Phone:763-657-0265
Mailing Address - Fax:612-236-1701
Practice Address - Street 1:1121 JACKSON ST NE
Practice Address - Street 2:105
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1672
Practice Address - Country:US
Practice Address - Phone:612-236-1712
Practice Address - Fax:612-236-1701
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301358101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)