Doctor Name: | DAVID L COLE |
NPI Number: | 1164660775 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW, LPHA |
License Number: | 149.011051 |
Business Practice Address: | 12 W Harrison St Sullivan, IL - 619511907 |
Business Phone Number: | 2177284358 |
Business Fax Number: | 2177282270 |
Mailing Address: | Po Box 163, 12 W. Harrison SULLIVAN |
State: | IL |
Postal Code: | 619510163 |
Phone Number: | 2177284358 |
Fax Number: | 2177282270 |
NPI Enumeration Date: | 02/04/2009 |
NPI Last Update Date: | 02/04/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149.011051 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |