Healthcare Provider Details

I. General information

NPI: 1770191751
Provider Name (Legal Business Name): ANGELIQUE MARIE COLEMAN NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELIQUE MARIE COLEMAN NCC, LPC

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 LINGLESTOWN RD STE 206
HARRISBURG PA
17112-8547
US

IV. Provider business mailing address

171 CHURCH ROAD #F
TURTLE CREEK PA
15145
US

V. Phone/Fax

Practice location:
  • Phone: 717-400-1871
  • Fax:
Mailing address:
  • Phone: 412-651-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC011908
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: