Individual
DR. WILLIE J. COLEMAN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
481 GOLD STAR HWY, SUITE 301, GROTON, CT 06340-6224
(860) 405-0490
(860) 885-0384
Mailing address
PO BOX 2081, SALEM, CT 06420-2081
(860) 405-0490
(860) 449-9146
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
000919
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004048088
—
CT
Enumeration date
07/27/2006
Last updated
04/16/2013
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