Healthcare Provider Details

I. General information

NPI: 1144778614
Provider Name (Legal Business Name): CHRISTOPHER J COLEMAN LPC, CSAC, MAC, CCDP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192543 ROGERS CLARK BOULEVARD
RUTHER GLEN VA
22546-3454
US

IV. Provider business mailing address

9633 LANDCASTLE DR
ASHLAND VA
23005-7874
US

V. Phone/Fax

Practice location:
  • Phone: 804-633-9997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006732
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: