Provider Demographics
NPI:1952813685
Name:COLEMAN, KHALID AMIR
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:AMIR
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 EVERETT ST APT 2025
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-4294
Mailing Address - Country:US
Mailing Address - Phone:804-484-2558
Mailing Address - Fax:
Practice Address - Street 1:5705 S LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-4420
Practice Address - Country:US
Practice Address - Phone:804-737-3917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst