Healthcare Provider Details

I. General information

NPI: 1346596590
Provider Name (Legal Business Name): KARISSA DIANE COLEMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9356 GOODMAN RD UNIT 3
OLIVE BRANCH MS
38654-1700
US

IV. Provider business mailing address

40 PICKWICK PLACE
BYHALIA MS
38611
US

V. Phone/Fax

Practice location:
  • Phone: 662-469-6270
  • Fax: 855-975-2540
Mailing address:
  • Phone: 662-469-6270
  • Fax: 855-975-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2801
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: