Provider Demographics
NPI:1245451103
Name:COLEMAN, DAVID KEITH (DMIN, LMHC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KEITH
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DMIN, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WATERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN PINES
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1717
Mailing Address - Country:US
Mailing Address - Phone:774-270-0844
Mailing Address - Fax:
Practice Address - Street 1:130 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3176
Practice Address - Country:US
Practice Address - Phone:603-890-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health