Provider Demographics
NPI:1912587296
Name:COLEMAN, STEPHANIE T (LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:T
Last Name:COLEMAN
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DASHARON LN
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7298
Mailing Address - Country:US
Mailing Address - Phone:678-850-4142
Mailing Address - Fax:844-991-1827
Practice Address - Street 1:8570 RIVERS AVE STE 161
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9893
Practice Address - Country:US
Practice Address - Phone:678-850-4142
Practice Address - Fax:844-991-1827
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10160101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC3002Medicaid