Provider Demographics
NPI:1528307139
Name:COLEMAN, WELLINGTON JOHN JR (PHD)
Entity type:Individual
Prefix:DR
First Name:WELLINGTON
Middle Name:JOHN
Last Name:COLEMAN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:WELLINGTON
Other - Middle Name:JOHN
Other - Last Name:COLEMAN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PHD, RN, LPC
Mailing Address - Street 1:3308 TULANE AVE SUITE 304
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119
Mailing Address - Country:US
Mailing Address - Phone:504-354-2090
Mailing Address - Fax:504-354-2090
Practice Address - Street 1:4301 ELYSIAN FIELDS AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-7400
Practice Address - Country:US
Practice Address - Phone:504-813-1283
Practice Address - Fax:504-246-2373
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA.2651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional