Provider Demographics
NPI:1811270218
Name:COLEMAN, DAVID JOHN II (LCSW, CADC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:COLEMAN
Suffix:II
Gender:M
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 S CHICAGO BEACH DR APT 2716N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2171
Mailing Address - Country:US
Mailing Address - Phone:847-845-3112
Mailing Address - Fax:
Practice Address - Street 1:1111 S HOMAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-4346
Practice Address - Country:US
Practice Address - Phone:847-845-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical