Provider Demographics
NPI:1235994286
Name:COLEMAN, BREANNA NICOLE
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:NICOLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10005 ROSE BROOK LN
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3379
Mailing Address - Country:US
Mailing Address - Phone:803-372-2061
Mailing Address - Fax:
Practice Address - Street 1:16409 NORTHCROSS DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5065
Practice Address - Country:US
Practice Address - Phone:980-441-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician