Provider Demographics
NPI:1366087728
Name:MADDOX-COLEMAN, JAZZMIN STAR (LPC)
Entity type:Individual
Prefix:MRS
First Name:JAZZMIN
Middle Name:STAR
Last Name:MADDOX-COLEMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JAZZMIN
Other - Middle Name:STAR
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3386 HOLLAND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4818
Mailing Address - Country:US
Mailing Address - Phone:757-343-6575
Mailing Address - Fax:757-500-0101
Practice Address - Street 1:3386 HOLLAND RD STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4818
Practice Address - Country:US
Practice Address - Phone:757-343-6575
Practice Address - Fax:757-500-0101
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008753101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional