Provider Demographics
NPI:1740558154
Name:COLEMAN, SHERYL (LMSW)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-3620
Mailing Address - Country:US
Mailing Address - Phone:269-501-6655
Mailing Address - Fax:
Practice Address - Street 1:5805 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1118
Practice Address - Country:US
Practice Address - Phone:269-323-1954
Practice Address - Fax:269-323-4183
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010901301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical