Provider Demographics
NPI:1770191751
Name:COLEMAN, ANGELIQUE MARIE (NCC, LPC)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:MARIE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:ANGELIQUE
Other - Middle Name:MARIE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCC, LPC
Mailing Address - Street 1:171 CHURCH ROAD #F
Mailing Address - Street 2:
Mailing Address - City:TURTLE CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:15145
Mailing Address - Country:US
Mailing Address - Phone:412-651-1120
Mailing Address - Fax:
Practice Address - Street 1:4755 LINGLESTOWN RD STE 206
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-8547
Practice Address - Country:US
Practice Address - Phone:717-400-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011908101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional