Provider Demographics
NPI:1194171165
Name:COLEMAN, VILISIA ANN
Entity type:Individual
Prefix:MISS
First Name:VILISIA
Middle Name:ANN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VILISIA
Other - Middle Name:ANN
Other - Last Name:COLEMAN-JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:916 FALCONHEAD LN
Mailing Address - Street 2:UNIT 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-2277
Mailing Address - Country:US
Mailing Address - Phone:702-578-2063
Mailing Address - Fax:
Practice Address - Street 1:2725 S JONES BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5667
Practice Address - Country:US
Practice Address - Phone:702-778-3004
Practice Address - Fax:702-384-2279
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical