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NPI Code Detail

MEDICARE: MISS TRACY LENORA COLEMAN CEO

MEDICARE: MISS TRACY LENORA COLEMAN CEO
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
1101YM0800XMental Health Counselor1912VA

Other Identifiers

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

General Provider Information

NPI Number : 1972940039
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS TRACY LENORA COLEMAN CEO
Provider Business Mailing Address
First Line : PO BOX 6015
Second Line :
City : PETERSBURG
State : VA
Zip : 23805-6015
Country : US
Telephone Number : 757-637-8764
Fax Number : 804-895-6884
Provider Business Practice Location Address
First Line : 10537 S CRATER RD
Second Line :
City : SOUTH PRINCE GEORGE
State : VA
Zip : 23805-7333
Country : US
Telephone Number : 757-637-8764
Fax Number : 804-895-6884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2013
Last Update Date : 05/30/2013

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