Provider Demographics
NPI:1730862350
Name:COLEMAN, MONYCIA
Entity type:Individual
Prefix:
First Name:MONYCIA
Middle Name:
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 1:151 N PLATINUM DR APT 4
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-7340
Mailing Address - Country:US
Mailing Address - Phone:870-623-7555
Mailing Address - Fax:
Practice Address - Street 1:7255 MEESHOW DR STE A
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5269
Practice Address - Country:US
Practice Address - Phone:479-306-4480
Practice Address - Fax:479-306-4488
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)