Provider Demographics
NPI:1316298763
Name:COLEMAN, JEWEL NICOLE' (LCAS-A)
Entity type:Individual
Prefix:MS
First Name:JEWEL
Middle Name:NICOLE'
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:MS
Other - First Name:JEWEL
Other - Middle Name:NICOLE'
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSAC
Mailing Address - Street 1:214 HAYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-1526
Mailing Address - Country:US
Mailing Address - Phone:919-696-0760
Mailing Address - Fax:
Practice Address - Street 1:214 HAYWOOD ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1526
Practice Address - Country:US
Practice Address - Phone:919-696-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2419101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health