Individual
MIKAYLA COLEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
416 WEEKS AVE, MANORVILLE, NY 11949-2036
(631) 284-8824
Mailing address
14202 20TH AVE, FLUSHING, NY 11351-3000
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/12/2024
Last updated
02/12/2024
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