Provider Demographics
NPI:1427421858
Name:WILSON, COLEMAN MITCHELL (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:COLEMAN
Middle Name:MITCHELL
Last Name:WILSON
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3312 KALISTE SALOOM RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7449
Mailing Address - Country:US
Mailing Address - Phone:337-534-0727
Mailing Address - Fax:337-534-0737
Practice Address - Street 1:3312 KALISTE SALOOM RD BLDG 1
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7449
Practice Address - Country:US
Practice Address - Phone:337-534-0727
Practice Address - Fax:337-534-0737
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LALPC6286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional