Provider Demographics
NPI:1013005933
Name:COLE, LAVON MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:LAVON
Middle Name:MARIE
Last Name:COLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 E CHUBBUCK ROAD
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5055
Mailing Address - Country:US
Mailing Address - Phone:208-237-1711
Mailing Address - Fax:208-237-9806
Practice Address - Street 1:265 E CHUBBUCK ROAD
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-5055
Practice Address - Country:US
Practice Address - Phone:208-237-1711
Practice Address - Fax:208-237-9806
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health