Provider Demographics
NPI:1619003274
Name:COLEMAN, MIREAN FISHER (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:MIREAN
Middle Name:FISHER
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 LEFRAK CT
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2955
Mailing Address - Country:US
Mailing Address - Phone:703-437-4528
Mailing Address - Fax:
Practice Address - Street 1:1604 LEFRAK CT
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-2955
Practice Address - Country:US
Practice Address - Phone:703-437-4528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3002811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical