Provider Demographics
NPI:1538658299
Name:COLEMAN, ALYSSA (LCDCII)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LCDCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 IMPERIAL CT APT 5
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2034
Mailing Address - Country:US
Mailing Address - Phone:720-951-6973
Mailing Address - Fax:
Practice Address - Street 1:705 S BROWN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-3113
Practice Address - Country:US
Practice Address - Phone:937-890-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCII.161557101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)