Healthcare Provider Details

I. General information

NPI: 1548687452
Provider Name (Legal Business Name): COLEMAN INSTITUTE RICHMOND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 02/23/2025
Certification Date: 02/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 N HAMILTON ST SUITE B
RICHMOND VA
23221-2662
US

IV. Provider business mailing address

204 N HAMILTON ST SUITE B
RICHMOND VA
23221-2662
US

V. Phone/Fax

Practice location:
  • Phone: 804-353-1230
  • Fax: 804-353-3342
Mailing address:
  • Phone: 804-353-1230
  • Fax: 804-353-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101037152
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER GIFFORD
Title or Position: CEO
Credential:
Phone: 804-307-0818