Provider Demographics
NPI:1609064740
Name:COLEMAN, BLANCHE ELAINE (LCAS)
Entity Type:Individual
Prefix:MRS
First Name:BLANCHE
Middle Name:ELAINE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:MISS
Other - First Name:BLANCHE
Other - Middle Name:ELAINE
Other - Last Name:STRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 BILLINGSLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1072
Mailing Address - Country:US
Mailing Address - Phone:704-376-7447
Mailing Address - Fax:704-376-3384
Practice Address - Street 1:100 BILLINGSLEY ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1072
Practice Address - Country:US
Practice Address - Phone:704-376-7447
Practice Address - Fax:704-376-3384
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112198Medicaid