Provider Demographics
NPI:1962184044
Name:COLEMAN, CHAQUENA DENISE (SUPERVISEE IN SW)
Entity type:Individual
Prefix:
First Name:CHAQUENA
Middle Name:DENISE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:SUPERVISEE IN SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5813 GLORYVINE CT APT 204-11
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-6952
Mailing Address - Country:US
Mailing Address - Phone:804-972-2684
Mailing Address - Fax:
Practice Address - Street 1:5813 GLORYVINE CT APT 204-11
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-6952
Practice Address - Country:US
Practice Address - Phone:804-972-2684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker