Provider Demographics
NPI:1861624496
Name:COLEMAN, MONICA LATRICE (LPC)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LATRICE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 BALD EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7752
Mailing Address - Country:US
Mailing Address - Phone:678-656-5127
Mailing Address - Fax:770-957-3012
Practice Address - Street 1:360 BALD EAGLE WAY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7752
Practice Address - Country:US
Practice Address - Phone:678-656-5127
Practice Address - Fax:770-957-3012
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004449101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional