Healthcare Provider Details

I. General information

NPI: 1457239857
Provider Name (Legal Business Name): YAHDIYA COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 21ST ST STE 8122
SACRAMENTO CA
95811-5226
US

IV. Provider business mailing address

7413 SUNSPARK LN
SACRAMENTO CA
95828-6239
US

V. Phone/Fax

Practice location:
  • Phone: 805-910-7455
  • Fax:
Mailing address:
  • Phone: 310-654-3829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW138842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: