Provider Demographics
NPI:1679218010
Name:COLEMAN, BREANNA J (LGPC)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:J
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4522
Mailing Address - Country:US
Mailing Address - Phone:240-380-6788
Mailing Address - Fax:
Practice Address - Street 1:2321 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-4522
Practice Address - Country:US
Practice Address - Phone:240-380-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-30
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11210101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health