1578526083 NPI number — ELAINE M COLE LCSW

Table of content: ELAINE M COLE LCSW (NPI 1578526083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578526083 NPI number — ELAINE M COLE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
ELAINE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578526083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 HAMILTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BOSTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24592-5200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-572-6916
Provider Business Mailing Address Fax Number:
434-572-4881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
523 MADISON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYDTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-738-0154
Provider Business Practice Location Address Fax Number:
434-738-9545
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904001968 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1700890761 - GR. NPI , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 267381 . This is a "ANTHEM, HLTHKPRS (BRUN)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 518755 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: O89897 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 267382 . This is a "ANTHEM, HLTHKPRS (MECK)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 267379 . This is a "ANTHEM, HLTHKPRS (HAL)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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