Healthcare Provider Details

I. General information

NPI: 1548538572
Provider Name (Legal Business Name): JAY C COLEMAN JR. ALC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 EDINBURGH DR
MONTGOMERY AL
36116-2105
US

IV. Provider business mailing address

2225 EDINBURGH DR
MONTGOMERY AL
36116-2105
US

V. Phone/Fax

Practice location:
  • Phone: 334-294-8717
  • Fax:
Mailing address:
  • Phone: 334-294-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC06025
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: