Healthcare Provider Details

I. General information

NPI: 1740754761
Provider Name (Legal Business Name): TEIA ANQWANETTE COLEMAN LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2019
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MORNING GAP PKWY
FORT MILL SC
29715-2542
US

IV. Provider business mailing address

PO BOX 23321
NEW YORK NY
10087-4321
US

V. Phone/Fax

Practice location:
  • Phone: 704-219-1180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14280
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8081
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: