Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor | 46.004879 | CT |
N | 101YP2500X | Professional Counselor | 4879 | CT |
NPI | 1003386939 |
---|---|
Provider Name | Darian Andre Coleman |
First Address | Middletown, CT 06457-8706 |
Second Address | Waterbury, CT 06708-3022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2018 |
Last Update Date | 27/04/2021 |