Individual
KANESHA ELAYNE COLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCAS
Contact information
Practice address
930 N PATTERSON AVE, WINSTON SALEM, NC 27101-1546
(336) 722-9951
(336) 722-5834
Mailing address
180 VISTA CT APT B, WINSTON SALEM, NC 27106-1967
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2029
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2029
NCSAPPB
NC
Enumeration date
02/23/2007
Last updated
05/15/2012
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