Healthcare Provider Details

I. General information

NPI: 1972591972
Provider Name (Legal Business Name): ROBERT EUGENE COLEMAN M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1158 PROFESSIONAL DR STE M
WILLIAMSBURG VA
23185-6618
US

IV. Provider business mailing address

PO BOX 819
WILLIAMSBURG VA
23187-0819
US

V. Phone/Fax

Practice location:
  • Phone: 757-258-5700
  • Fax: 757-253-2884
Mailing address:
  • Phone: 757-258-5700
  • Fax: 757-253-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0718000044
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701000627
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000178
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: