Healthcare Provider Details

I. General information

NPI: 1033390588
Provider Name (Legal Business Name): COLEMAN CHILD AND FAMILY SERVICES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 S 17TH ST STE 1
WILMINGTON NC
28401-6680
US

IV. Provider business mailing address

1907 S 17TH ST STE 1
WILMINGTON NC
28401-6680
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-8424
  • Fax: 910-343-6989
Mailing address:
  • Phone: 910-343-8424
  • Fax: 910-343-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2808
License Number StateNC

VIII. Authorized Official

Name: MRS. JENNIFER KING COLEMAN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 910-343-8424