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1114146156
JACK COLEMAN
LONG BEACH, CA
NPI
1114146156
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2007-04-25
Last Update Date
2007-07-08
Business Address
-- JACK COLEMAN
944 PACIFIC AVE
LONG BEACH, CA 90813-4228
Phone number: 562-436-3533
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Mailing Address
-- JACK COLEMAN
944 PACIFIC AVE
LONG BEACH, CA 90813-4228
Phone number:
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