Provider Demographics
NPI:1053451641
Name:COLEMAN, JOYCE E
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:E
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 1:1810 CRAI ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4761
Mailing Address - Country:US
Mailing Address - Phone:314-509-3310
Mailing Address - Fax:
Practice Address - Street 1:1810 CRAIG RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4760
Practice Address - Country:US
Practice Address - Phone:314-509-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0005021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical