Provider Demographics
NPI:1538327507
Name:COLEMAN, ETHEL (BA)
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 RTE 286 HWY E
Mailing Address - Street 2:524
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1461
Mailing Address - Country:US
Mailing Address - Phone:724-465-0964
Mailing Address - Fax:724-465-1081
Practice Address - Street 1:1380 RTE 286 HWY E
Practice Address - Street 2:524
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1461
Practice Address - Country:US
Practice Address - Phone:724-465-0964
Practice Address - Fax:724-465-1081
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health