Provider Demographics
NPI:1952143091
Name:COLEMAN, ALYSSA CHANTELLE (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CHANTELLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 CORMICHE LN
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3387
Mailing Address - Country:US
Mailing Address - Phone:984-272-6116
Mailing Address - Fax:
Practice Address - Street 1:4009 BARRETT DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6616
Practice Address - Country:US
Practice Address - Phone:984-221-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0205681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical