Provider Demographics
NPI:1669540548
Name:COLEMAN, JOSEPHINE C (LCSW, MAC)
Entity type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:C
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LCSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 OAK ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-6923
Mailing Address - Country:US
Mailing Address - Phone:912-442-0558
Mailing Address - Fax:912-442-0563
Practice Address - Street 1:150 BUTLER ST.
Practice Address - Street 2:SUITE D-3
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-6923
Practice Address - Country:US
Practice Address - Phone:912-442-0558
Practice Address - Fax:912-442-0563
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0030911041C0700X
AL1601C1041C0700X
GA507149101YA0400X
GA0030911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)