Provider Demographics
NPI:1225551641
Name:COLEMAN, YAZMIN GENESIS (LCSW, LISW, LCAS-A)
Entity Type:Individual
Prefix:MRS
First Name:YAZMIN
Middle Name:GENESIS
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LCSW, LISW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 REXHILL CT
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6491
Mailing Address - Country:US
Mailing Address - Phone:984-789-2502
Mailing Address - Fax:
Practice Address - Street 1:6410 CODA CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-1998
Practice Address - Country:US
Practice Address - Phone:984-789-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.21030001041C0700X
FLSW194951041C0700X
NCP0116941041C0700X
NCC0128881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0454532Medicaid
NC1295406106Medicaid