Healthcare Provider Details

I. General information

NPI: 1669540548
Provider Name (Legal Business Name): JOSEPHINE C COLEMAN LCSW, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BUTLER ST. SUITE D-3
MIDWAY GA
31320-6923
US

IV. Provider business mailing address

191 OAK ISLAND DR
MIDWAY GA
31320-6923
US

V. Phone/Fax

Practice location:
  • Phone: 912-442-0558
  • Fax: 912-442-0563
Mailing address:
  • Phone: 912-442-0558
  • Fax: 912-442-0563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003091
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1601C
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number507149
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number003091
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: