Provider Demographics
NPI:1497416143
Name:COLEMAN, KEVIN (MS, LPC LADC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MS, LPC LADC
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LADC, LPC
Mailing Address - Street 1:14 OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-2362
Mailing Address - Country:US
Mailing Address - Phone:860-995-4237
Mailing Address - Fax:
Practice Address - Street 1:14 OAKLAND ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2362
Practice Address - Country:US
Practice Address - Phone:860-995-4237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health