Provider Demographics
NPI:1548470628
Name:COLEMAN, AMANDA F (MAMFC, MACE)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:F
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MAMFC, MACE
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:288 STEELE RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-4714
Mailing Address - Country:US
Mailing Address - Phone:662-617-3733
Mailing Address - Fax:
Practice Address - Street 1:1014 N JACKSON ST STE F
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2211
Practice Address - Country:US
Practice Address - Phone:662-497-2049
Practice Address - Fax:662-244-2575
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
MS1406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health