Provider Demographics
NPI:1164443677
Name:COLEMAN, PAULA L (LCSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:L
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 1:841 BLISS ST
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-8943
Mailing Address - Country:US
Mailing Address - Phone:479-246-8152
Mailing Address - Fax:
Practice Address - Street 1:780 BUCKHORN FLATS RD STE 1
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-9612
Practice Address - Country:US
Practice Address - Phone:479-319-6579
Practice Address - Fax:479-319-6570
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1159-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X676OtherBLUE SHIELD PROVIDER #