Provider Demographics
NPI:1942673793
Name:COLEMAN, CHILITA NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:CHILITA
Middle Name:NICOLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 B CARTER STREET,
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373
Mailing Address - Country:US
Mailing Address - Phone:318-414-3065
Mailing Address - Fax:318-414-3067
Practice Address - Street 1:615 EE WALLACE BLVD S
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-3224
Practice Address - Country:US
Practice Address - Phone:318-757-9363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7248101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional