Provider Demographics
NPI:1114145927
Name:COLE, DEXTER AUDRE
Entity Type:Individual
Prefix:
First Name:DEXTER
Middle Name:AUDRE
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-3111
Mailing Address - Country:US
Mailing Address - Phone:562-981-1501
Mailing Address - Fax:562-981-1502
Practice Address - Street 1:2511 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-3111
Practice Address - Country:US
Practice Address - Phone:562-981-1501
Practice Address - Fax:562-981-1502
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)