Provider Demographics
NPI:1184099533
Name:JIMERSON-COLSTON, BELINDA (LCDC)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:
Last Name:JIMERSON-COLSTON
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 TEJAS PKWY
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-1358
Mailing Address - Country:US
Mailing Address - Phone:409-839-3857
Mailing Address - Fax:409-883-7076
Practice Address - Street 1:4303 TEJAS PKWY
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77632-1358
Practice Address - Country:US
Practice Address - Phone:409-839-3857
Practice Address - Fax:409-883-7076
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13226101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)