Provider Demographics
NPI:1013357748
Name:COLEY, FATIMA MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:MARIE
Last Name:COLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 THE CITY DRIVE SOUTH 2ND FL (MOB #44)
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-935-6363
Mailing Address - Fax:323-565-2133
Practice Address - Street 1:301 THE CITY DRIVE SOUTH 2ND FL (MOB #44)
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:323-525-6400
Practice Address - Fax:323-565-2133
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
390200000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program