=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932595337
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID COLEMAN MA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2015
-----------------------------------------------------
Last Update Date | 04/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 WARREN ST
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27403-2340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-856-8011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3102 CAMP RANGER LN
-----------------------------------------------------
City | JAMESTOWN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27282-8686
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGICAL ASSOCIATE
-----------------------------------------------------
Name | DAVID COLEMAN
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 336-856-8011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------