Provider Demographics
NPI:1992458970
Name:COLEMAN, DALE (PSYD, LMFT)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PSYD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12396 WORLD TRADE DR STE 109
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3787
Mailing Address - Country:US
Mailing Address - Phone:619-356-0788
Mailing Address - Fax:
Practice Address - Street 1:12396 WORLD TRADE DR STE 109
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3787
Practice Address - Country:US
Practice Address - Phone:619-356-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149940106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist