Healthcare Provider Details

I. General information

NPI: 1992579213
Provider Name (Legal Business Name): MR. DARRYL LEE COLEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S AUBURN ST
KENNEWICK WA
99336-5662
US

IV. Provider business mailing address

1175 CARONDELET DR
RICHLAND WA
99354-3300
US

V. Phone/Fax

Practice location:
  • Phone: 509-221-1225
  • Fax:
Mailing address:
  • Phone: 509-943-9104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: