Provider Demographics
NPI:1821360207
Name:COLEMAN, LATASHIA SHAWNTE (MCJ)
Entity Type:Individual
Prefix:MRS
First Name:LATASHIA
Middle Name:SHAWNTE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MCJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 VENTURE CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1604
Mailing Address - Country:US
Mailing Address - Phone:615-460-4200
Mailing Address - Fax:
Practice Address - Street 1:1200 2ND AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4110
Practice Address - Country:US
Practice Address - Phone:615-291-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor