1972529824 NPI number — MRS. YVONNE ICILDA COLE LCSW

Table of content: (NPI 1013574797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972529824 NPI number — MRS. YVONNE ICILDA COLE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
YVONNE
Provider Middle Name:
ICILDA
Provider Name Prefix Text:
MRS.
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:
1972529824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2819 COBB PLACE MANOR CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30066-3662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-640-4656
Provider Business Mailing Address Fax Number:
678-581-5560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6810 ROSWELL RD NE STE 2H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDY SPRINGS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30328-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-640-4656
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2006

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:  CSW002936 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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