Provider Demographics
NPI:1043665268
Name:COLEMAN, STEPHEN (CAP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 CORNELIA ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-3327
Mailing Address - Country:US
Mailing Address - Phone:850-717-9853
Mailing Address - Fax:850-561-8966
Practice Address - Street 1:3435 CORNELIA ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32305-3327
Practice Address - Country:US
Practice Address - Phone:850-717-9853
Practice Address - Fax:850-561-8966
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP4455101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)