Provider Demographics
NPI:1952821423
Name:COLEMAN, CALVIN DAVID (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:DAVID
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7207 N NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-4916
Mailing Address - Country:US
Mailing Address - Phone:813-236-1182
Mailing Address - Fax:
Practice Address - Street 1:7207 N NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-4916
Practice Address - Country:US
Practice Address - Phone:813-236-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101YA04000XMedicaid