Provider Demographics
NPI:1215814751
Name:COLEMAN-WILSON, LANCE MONTEZ (MSS, LCSW)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:MONTEZ
Last Name:COLEMAN-WILSON
Suffix:
Gender:M
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:LANCE
Other - Middle Name:MONTEZ
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSS, LCSW
Mailing Address - Street 1:406 DALMAS AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-2004
Mailing Address - Country:US
Mailing Address - Phone:484-474-0711
Mailing Address - Fax:
Practice Address - Street 1:406 DALMAS AVE
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-2004
Practice Address - Country:US
Practice Address - Phone:484-474-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical