Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY003313 | GA |
Y | 103G00000X | Clinical Psychologist | PSY003313 | GA |
Y | 103TC0700X | Clinical Psychologist | PSY003313 | GA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY003313 | GA |
N | 103TF0000X | Family Psychologist | PSY003313 | GA |
N | 103TF0200X | Forensic Psychologist | PSY003313 | GA |
N | 103TP2701X | Group Psychotherapist | PSY003313 | GA |
NPI | 1154654366 |
---|---|
Provider Name | Dr. Monique N. Coleman |
First Address | Fayetteville, GA 30214-0101 |
Second Address | Peachtree City, GA 30269-1554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2009 |
Last Update Date | 01/11/2012 |