MEDICARE: JENNIFER L COLEMAN LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	13880	NC

General Provider Information

NPI Number	:	1538377619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L COLEMAN LCMHC

Provider Business Mailing Address
First Line	:	145 VISTA DR
Second Line	:
City	:	DAVIDSON
State	:	NC
Zip	:	28036-7726
Country	:	US
Telephone Number	:	704-741-0692
Fax Number	:

Provider Business Practice Location Address
First Line	:	20605 N MAIN ST
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-8454
Country	:	US
Telephone Number	:	704-741-0692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2007
Last Update Date	:	02/12/2026

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