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Individual

JEREMY PAUL COLEMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCDCII

Contact information

Practice address
4977 NORTHCUTT PL, DAYTON, OH 45414-3839
(937) 387-6395
Mailing address
4977 NORTHCUTT PL, DAYTON, OH 45414-3839
(937) 387-6395

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCII.161841
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0291711
OH
Enumeration date
06/03/2018
Last updated
03/06/2023
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