Provider Demographics
NPI:1932660347
Name:COLEMAN, EBONY DENISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:EBONY
Middle Name:DENISE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1072 W PEACHTREE ST NW UNIT 7423
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30357-3004
Mailing Address - Country:US
Mailing Address - Phone:213-949-0150
Mailing Address - Fax:
Practice Address - Street 1:255 N FORBES ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-4759
Practice Address - Country:US
Practice Address - Phone:213-949-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist