Provider Demographics
NPI:1790150969
Name:COLEMAN, SAMANTHA B (MS, LPC, NCC)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:B
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:1701 WHITE STREET
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648
Mailing Address - Country:US
Mailing Address - Phone:601-249-4217
Mailing Address - Fax:601-249-4234
Practice Address - Street 1:1701 WHITE STREET
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648
Practice Address - Country:US
Practice Address - Phone:601-249-4217
Practice Address - Fax:601-249-4234
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5781101YM0800X
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health