Provider Demographics
NPI:1093191983
Name:COLE, SHATASHA LENISE (EDD, LICSW)
Entity Type:Individual
Prefix:DR
First Name:SHATASHA
Middle Name:LENISE
Last Name:COLE
Suffix:
Gender:F
Credentials:EDD, LICSW
Other - Prefix:DR
Other - First Name:SHATASHA
Other - Middle Name:LENISE
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD, LICSW
Mailing Address - Street 1:901 BOREN AVE STE 1300
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3509
Mailing Address - Country:US
Mailing Address - Phone:253-336-6468
Mailing Address - Fax:844-383-1077
Practice Address - Street 1:901 BOREN AVE STE 1300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3509
Practice Address - Country:US
Practice Address - Phone:253-336-6468
Practice Address - Fax:844-383-1077
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091915-1104100000X
WALW606286291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW60628629OtherLICSW
NY091915-1OtherLMSW