Provider Demographics
NPI:1851708234
Name:COLEMAN, CARL (LCPC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11616 SETTLERS CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4383
Mailing Address - Country:US
Mailing Address - Phone:240-281-8487
Mailing Address - Fax:301-428-4940
Practice Address - Street 1:3 EXECUTIVE PARK CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2643
Practice Address - Country:US
Practice Address - Phone:240-281-8487
Practice Address - Fax:301-428-4940
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5467101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health