Provider Demographics
NPI:1548433568
Name:COLEMAN, EDWARD CLARANCE JR (CAC-M)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:CLARANCE
Last Name:COLEMAN
Suffix:JR
Gender:M
Credentials:CAC-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 EDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48505-3742
Mailing Address - Country:US
Mailing Address - Phone:810-787-4536
Mailing Address - Fax:
Practice Address - Street 1:939 MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503
Practice Address - Country:US
Practice Address - Phone:810-232-2091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)