MEDICARE: ANGELIQUE MARIE COLEMAN NCC, LPC

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	101YP2500X	Professional Counselor	PC011908	PA

General Provider Information

NPI Number	:	1770191751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELIQUE MARIE COLEMAN NCC, LPC

Provider Business Mailing Address
First Line	:	171 CHURCH ROAD #F
Second Line	:
City	:	TURTLE CREEK
State	:	PA
Zip	:	15145
Country	:	US
Telephone Number	:	412-651-1120
Fax Number	:

Provider Business Practice Location Address
First Line	:	4755 LINGLESTOWN RD STE 206
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-8547
Country	:	US
Telephone Number	:	717-400-1871
Fax Number	:

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

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	07/16/2020

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