Provider Demographics
NPI:1275953895
Name:COWN, COLEMAN (LPC-I, MED)
Entity Type:Individual
Prefix:
First Name:COLEMAN
Middle Name:
Last Name:COWN
Suffix:
Gender:M
Credentials:LPC-I, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SEDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1858
Mailing Address - Country:US
Mailing Address - Phone:770-601-9683
Mailing Address - Fax:
Practice Address - Street 1:1530 S HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4620
Practice Address - Country:US
Practice Address - Phone:864-906-2395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional