Active NPI
Tracy Lenora Coleman, CEO
- Mental Health Counselor
- South Prince George, VA
National Provider Identifier
1972940039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1912
- Practice address
- 10537 S Crater Rd
South Prince George, VA 23805-7333 - Phone
- (757) 637-8764
- Fax
- (804) 895-6884
- NPI assigned
- May 30, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1912 | VA | Primary |
Addresses
Primary practice location
10537 S Crater Rd
South Prince George, VA 23805-7333
Mailing address
PO Box 6015
Petersburg, VA 23805-6015
Phone (757) 637-8764
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1912 | VA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369872000000",
"number": "1972940039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6015",
"city": "PETERSBURG",
"state": "VA",
"postal_code": "238056015",
"telephone_number": "757-637-8764",
"fax_number": "804-895-6884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10537 S CRATER RD",
"city": "SOUTH PRINCE GEORGE",
"state": "VA",
"postal_code": "238057333",
"telephone_number": "757-637-8764",
"fax_number": "804-895-6884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLEMAN",
"first_name": "TRACY",
"middle_name": "LENORA",
"name_prefix": "Miss",
"credential": "CEO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-30",
"last_updated": "2013-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "VA",
"license": "1912",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1912",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Prince George, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.