Provider Demographics
NPI:1366943268
Name:COLEMAN, LERON (CPRM)
Entity type:Individual
Prefix:
First Name:LERON
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:CPRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2349
Mailing Address - Country:US
Mailing Address - Phone:248-396-9928
Mailing Address - Fax:248-334-8928
Practice Address - Street 1:54 SENECA ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2349
Practice Address - Country:US
Practice Address - Phone:248-396-9928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-3042347OtherTURNING POINT RECOVERY CENTER