Provider Demographics
NPI:1760567895
Name:COLEMAN, WAYNE CARLTON (CAT)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:CARLTON
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:CAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 JONES ST
Mailing Address - Street 2:APT F
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-7089
Mailing Address - Country:US
Mailing Address - Phone:318-473-0010
Mailing Address - Fax:318-483-5176
Practice Address - Street 1:2495 SHREVEPORT HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4044
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:318-483-5176
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)