Healthcare Provider Details

I. General information

NPI: 1457038218
Provider Name (Legal Business Name): MACI COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 BELINDA PKWY STE 101
MT JULIET TN
37122-4399
US

IV. Provider business mailing address

542 AMHERST ST STE B
NASHUA NH
03063-1016
US

V. Phone/Fax

Practice location:
  • Phone: 615-975-1213
  • Fax:
Mailing address:
  • Phone: 704-247-6257
  • Fax: 704-247-6257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-802111
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: