Provider Demographics
NPI:1225714462
Name:COLEMAN, BRENDA L (LSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 ALPINE CT
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:WV
Mailing Address - Zip Code:26150-3014
Mailing Address - Country:US
Mailing Address - Phone:304-483-0542
Mailing Address - Fax:
Practice Address - Street 1:225 ALPINE CT
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:WV
Practice Address - Zip Code:26150-3014
Practice Address - Country:US
Practice Address - Phone:304-483-0542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AP00941303104100000X
WVAP00941303104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty