Provider Demographics
NPI:1508272402
Name:COLEMAN, SELENA (DD, LCCT)
Entity Type:Individual
Prefix:DR
First Name:SELENA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DD, LCCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160014
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1001
Mailing Address - Country:US
Mailing Address - Phone:678-908-8371
Mailing Address - Fax:
Practice Address - Street 1:434 FLAT SHOALS AVE SE STE 5
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-1915
Practice Address - Country:US
Practice Address - Phone:678-908-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA09173982101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral