Provider Demographics
NPI:1932239654
Name:SMITH COLEMAN, ALICE MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:MARIE
Last Name:SMITH COLEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 KIAMENSI ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3421
Mailing Address - Country:US
Mailing Address - Phone:302-998-6439
Mailing Address - Fax:302-998-6439
Practice Address - Street 1:907 KIAMENSI ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-3421
Practice Address - Country:US
Practice Address - Phone:302-998-6439
Practice Address - Fax:302-998-6439
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ100000901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000036291Medicaid
DEIP292150OtherMAGELLAN
DE4125184OtherTRICARE
DE491657Medicare ID - Type Unspecified
DE1000036291Medicaid