Provider Demographics
NPI:1124506555
Name:COLEMAN, ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:CHICHESTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:17 HAMPDEN CT APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-2800
Mailing Address - Country:US
Mailing Address - Phone:610-716-3850
Mailing Address - Fax:
Practice Address - Street 1:3030 ASHLEY TOWN CENTER DR STE 203B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5678
Practice Address - Country:US
Practice Address - Phone:843-310-3539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1518103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical