Provider Demographics
NPI:1205253796
Name:COLEMAN, JENNY LYNN (LSW)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:PHARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:131 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-5402
Mailing Address - Country:US
Mailing Address - Phone:304-872-6503
Mailing Address - Fax:304-872-5415
Practice Address - Street 1:70 PARCOAL RD
Practice Address - Street 2:
Practice Address - City:WEBSTER SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:26288-9767
Practice Address - Country:US
Practice Address - Phone:304-847-5425
Practice Address - Fax:304-847-5422
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00941815104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker