Provider Demographics
NPI:1356190870
Name:COLEMAN, GINGER R
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:R
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8814 CITRUS VILLAGE DR APT 204
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3694
Mailing Address - Country:US
Mailing Address - Phone:502-457-3229
Mailing Address - Fax:
Practice Address - Street 1:8814 CITRUS VILLAGE DR APT 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3694
Practice Address - Country:US
Practice Address - Phone:502-457-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-357369106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician