Provider Demographics
NPI:1003230210
Name:COLE, RIVETTE (LCASA)
Entity Type:Individual
Prefix:
First Name:RIVETTE
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 BOLLA DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-4592
Mailing Address - Country:US
Mailing Address - Phone:910-797-6511
Mailing Address - Fax:910-491-1000
Practice Address - Street 1:2820 BOLLA DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-4952
Practice Address - Country:US
Practice Address - Phone:910-797-6511
Practice Address - Fax:910-491-1000
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP007442OtherNCSWB