Provider Demographics
NPI:1740536366
Name:COLEMAN, DARIUS PAUL (MHC-LP)
Entity type:Individual
Prefix:MR
First Name:DARIUS
Middle Name:PAUL
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 W 121ST ST
Mailing Address - Street 2:APT 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6289
Mailing Address - Country:US
Mailing Address - Phone:770-990-4755
Mailing Address - Fax:
Practice Address - Street 1:810 CLASSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6102
Practice Address - Country:US
Practice Address - Phone:718-295-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP84906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health