1598275315 NPI number — TINA MARIE COLE LPC, NCC

Table of content: TINA MARIE COLE LPC, NCC (NPI 1598275315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598275315 NPI number — TINA MARIE COLE LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
TINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILKENS
Provider Other First Name:
TINA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598275315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
195 MOUNT LAUREL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINES
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16921-9530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-215-9490
Provider Business Mailing Address Fax Number:
570-203-2293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 MOUNT LAUREL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINES
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16921-9530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-215-9490
Provider Business Practice Location Address Fax Number:
570-203-2293
Provider Enumeration Date:
10/06/2017

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: 101YP2500X , with the licence number:  PC009499 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 104094732-000 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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