Provider Demographics
NPI:1689416760
Name:COLEMAN, CAROL ADELE (MFT)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ADELE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:ADELE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:910 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4128
Mailing Address - Country:US
Mailing Address - Phone:707-696-9533
Mailing Address - Fax:
Practice Address - Street 1:910 FIRST ST
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4128
Practice Address - Country:US
Practice Address - Phone:707-696-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT30330101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty