Provider Demographics
NPI:1578679635
Name:COLEMAN, KENYA D (LICSW)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:D
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 CHILLUM RD
Mailing Address - Street 2:APARTMENT 202
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3328
Mailing Address - Country:US
Mailing Address - Phone:254-216-1733
Mailing Address - Fax:
Practice Address - Street 1:710 CHILLUM RD
Practice Address - Street 2:APARTMENT 202
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3328
Practice Address - Country:US
Practice Address - Phone:254-216-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500782371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical