Individual provider Active NPI

Lakrisha Coleman

  • Clinical Social Worker
  • Huntsville, AL
National Provider Identifier
1891163390
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
4758C Issued in AL
Practice address
4040 Memorial Pkwy SW
Huntsville, AL 35802-4364
Phone
(256) 533-1970
Fax
(256) 705-6477
NPI assigned
Sep 14, 2015
Last updated
Sep 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 3301G AL
Clinical Social Worker 1041C0700X 4758C AL Primary

Addresses

Primary practice location

4040 Memorial Pkwy SW
Huntsville, AL 35802-4364

Mailing address

2512 Norman Ter NW
Huntsville, AL 35810-3926
Phone (256) 783-5957

Other identifiers 1

IdentifierTypeStateIssuer
330000014MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221102001181 AL Practitioner - Clinical Social Worker 4385011469 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1100 Jordan LN NW
Suite M
Huntsville, AL 35816-3030
Phone (256) 932-2475

2512 Norman Ter NW
Huntsville, AL 35810-3926

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3301GALMDSocial Worker
4758CALMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Peaceful Pathways LLC Clinical CurrentSince Aug 1, 2022 Accepting new patients
Hearts to Heal Counseling and Consultation Clinical CurrentSince Apr 9, 2024 Accepting new patients

Locations

1100 Jordan Ln NW
Ste M
Huntsville, AL 35816
Phone (256) 932-2475

120 W Dublin Dr
Ste 202
Madison, AL 35758
Phone (256) 929-5507

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1891163390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2512 NORMAN TER NW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358103926",
            "telephone_number": "256-783-5957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 MEMORIAL PKWY SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358024364",
            "telephone_number": "256-533-1970",
            "fax_number": "256-705-6477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "LAKRISHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-14",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AL",
            "license": "3301G",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "4758C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330000014",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AL

Sources for this page

Verify at the official NPI Registry.