Healthcare Provider Details

I. General information

NPI: 1821328873
Provider Name (Legal Business Name): MEGAN MARIE COLEMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 GREENWOOD AVE SE
GRAND RAPIDS MI
49506-2909
US

IV. Provider business mailing address

1019 SAN LUCIA DR SE
GRAND RAPIDS MI
49506-3456
US

V. Phone/Fax

Practice location:
  • Phone: 734-276-0556
  • Fax:
Mailing address:
  • Phone: 734-276-0556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092808
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: