COLEMAN, VICTORIA DOREE (EDD)

Provider Demographics

• NPI: 1932315447
• Name: COLEMAN, VICTORIA DOREE (EDD)
• Entity Type: Individual
• Prefix: DR
• First Name: VICTORIA
• Middle Name: DOREE
• Last Name: COLEMAN
• Gender: F
• Credentials: EDD
• Other - Prefix: DR
• Other - First Name: VICKI
• Other - Middle Name: DOREE
• Other - Last Name: COLEMAN
• Other - Last Name Type: Professional Name
• Other - Credentials: EDD
• Mailing Address - Street 1: 9811 W CHARLESTON BLVD
• Mailing Address - Street 2: SUITE 2-376
• Mailing Address - City: LAS VEGAS
• Mailing Address - State: NV
• Mailing Address - Zip Code: 89117-7528
• Mailing Address - Country: US
• Mailing Address - Phone: 702-220-5300
• Mailing Address - Fax: 708-405-4105
• Practice Address - Street 1: 9811 W CHARLESTON BLVD
• Practice Address - Street 2: SUITE 2-376
• Practice Address - City: LAS VEGAS
• Practice Address - State: NV
• Practice Address - Zip Code: 89117-7528
• Practice Address - Country: US
• Practice Address - Phone: 702-220-5300
• Practice Address - Fax: 708-405-4105
• Is Sole Proprietor?: Yes
• Enumeration Date: 2007-05-15
• Last Update Date: 2016-12-12

Provider Licenses

State	License ID	Taxonomies
	17914	101YA0400X
MI	6401000417	101YP2500X
		103TC1900X, 133NN1002X, 1744R1102X, 175F00000X, 175L00000X
IN	34002388A	1041C0700X
IN	35000688A	106H00000X
CA	976	101YP2500X
IL	180.008854	101YP2500X
	22868	101YM0800X
NV	CP0164	101YP2500X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	101YP2500X	Behavioral Health & Social Service Providers	Counselor	Professional
No	101YA0400X	Behavioral Health & Social Service Providers	Counselor	Addiction (Substance Use Disorder)
No	103TC1900X	Behavioral Health & Social Service Providers	Psychologist	Counseling
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical
No	106H00000X	Behavioral Health & Social Service Providers	Marriage & Family Therapist
No	133NN1002X	Dietary & Nutritional Service Providers	Nutritionist	Nutrition, Education
No	1744R1102X	Other Service Providers	Specialist	Research Study
No	175F00000X	Other Service Providers	Naturopath
No	175L00000X	Other Service Providers	Homeopath
No	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health