Healthcare Provider Details

I. General information

NPI: 1275953895
Provider Name (Legal Business Name): COLEMAN COWN LPC-I, M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 S HIGHWAY 14
GREER SC
29650-4620
US

IV. Provider business mailing address

16 SEDGEFIELD DR
GREENVILLE SC
29615-1858
US

V. Phone/Fax

Practice location:
  • Phone: 864-906-2395
  • Fax:
Mailing address:
  • Phone: 770-601-9683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5868
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: