MEDICARE: MS. TEIA ANQWANETTE COLEMAN LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	8081	SC
2	101YM0800X	Mental Health Counselor	14280	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740754761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TEIA ANQWANETTE COLEMAN LCMHC

Provider Business Mailing Address
First Line	:	PO BOX 23321
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-4321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 MORNING GAP PKWY
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-2542
Country	:	US
Telephone Number	:	704-219-1180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2019
Last Update Date	:	01/29/2026

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