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Individual

BLAINE COLEMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1401 S 4TH ST, 4TH FLOOR, PHILADELPHIA, PA 19147-5907
(215) 339-1070
Mailing address
432 N 6TH ST, PHILADELPHIA, PA 19123-4004

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
06/04/2008
Last updated
06/04/2008
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