Provider Demographics
NPI:1801633391
Name:COLEMAN, NICHELLE SHENITA (WELLNESS COACH/PEER)
Entity type:Individual
Prefix:
First Name:NICHELLE
Middle Name:SHENITA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:WELLNESS COACH/PEER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7955 MAGNOLIA AVE APT 16B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3490
Mailing Address - Country:US
Mailing Address - Phone:702-712-3591
Mailing Address - Fax:
Practice Address - Street 1:3650 W MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-1700
Practice Address - Country:US
Practice Address - Phone:951-386-6204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No175T00000XOther Service ProvidersPeer Specialist