Provider Demographics
NPI:1114221173
Name:COLEMAN, JESSICA RAFFAELE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAFFAELE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 BRIGHT LOOP
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-6939
Mailing Address - Country:US
Mailing Address - Phone:704-953-8235
Mailing Address - Fax:
Practice Address - Street 1:204 N PERSON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1047
Practice Address - Country:US
Practice Address - Phone:919-834-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0070581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical