Healthcare Provider Details

I. General information

NPI: 1588651483
Provider Name (Legal Business Name): MICHELLE S. COLEMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SHACKLEFORD PLZ STE 202A
LITTLE ROCK AR
72211-1844
US

IV. Provider business mailing address

11415 HURON LN UNIT 22205
LITTLE ROCK AR
72221-7125
US

V. Phone/Fax

Practice location:
  • Phone: 501-588-7800
  • Fax:
Mailing address:
  • Phone: 501-588-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11619
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00883200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP0501002
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: