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General NPI Number Information
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NPI Number | 1124506555
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Entity Type | Individual
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Provider Name | ELIZABETH COLEMAN PHD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2018
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Last Update Date | 07/28/2018
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Provider Practice Location Address
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Address Line | 3030 ASHLEY TOWN CENTER DR STE 203B
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City | CHARLESTON
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State | SC
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Zip | 29414-5678
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Country | US
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Telephone | 843-310-3539
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Fax |
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Provider Business Mailing Address
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Address Line | 17 HAMPDEN CT APT A
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City | CHARLESTON
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State | SC
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Zip | 29403-2800
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Country | US
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Telephone | 610-716-3850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1518
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License Number State | SC
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