Healthcare Provider Details

I. General information

NPI: 1245451103
Provider Name (Legal Business Name): DAVID KEITH COLEMAN D.MIN, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MAIN ST SUITE 204
SALEM NH
03079-3176
US

IV. Provider business mailing address

101 WATERTOWN RD
OCEAN PINES MD
21811-1717
US

V. Phone/Fax

Practice location:
  • Phone: 603-890-6767
  • Fax:
Mailing address:
  • Phone: 774-270-0844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6040
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: