Provider Demographics
NPI:1568874774
Name:COLEMAN, CAROLYN LAVERNE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LAVERNE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 ASHLEY CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4327
Mailing Address - Country:US
Mailing Address - Phone:404-931-3316
Mailing Address - Fax:
Practice Address - Street 1:3006 ASHLEY CLUB CIR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4327
Practice Address - Country:US
Practice Address - Phone:404-931-3316
Practice Address - Fax:770-695-0213
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health