Provider Demographics
NPI:1831919448
Name:COLEMAN CHILD PSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:COLEMAN CHILD PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAKA-MONIQUE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, HSP-P
Authorized Official - Phone:919-446-3334
Mailing Address - Street 1:1029 COMMACK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6771
Mailing Address - Country:US
Mailing Address - Phone:832-404-3635
Mailing Address - Fax:
Practice Address - Street 1:150 PROVIDENCE RD STE 101
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2208
Practice Address - Country:US
Practice Address - Phone:919-446-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical