Healthcare Provider Details

I. General information

NPI: 1255886354
Provider Name (Legal Business Name): KIRSTIN COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 BRANCH AVE SE
WASHINGTON DC
20019-2159
US

IV. Provider business mailing address

1126 BRANCH AVE SE
WASHINGTON DC
20019-2159
US

V. Phone/Fax

Practice location:
  • Phone: 202-258-4901
  • Fax:
Mailing address:
  • Phone: 202-258-4901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: