=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730995622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEPHANIE COLEMAN, MENTAL HEALTH PROFESSIONAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2024
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8570 RIVERS AVE STE 161
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406-9893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-850-4142
-----------------------------------------------------
Fax | 844-991-1827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 DASHARON LN
-----------------------------------------------------
City | GOOSE CREEK
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29445-7298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-850-4142
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. STEPHANIE COLEMAN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 678-850-4142
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------