Provider Demographics
NPI:1124183215
Name:COLE, CONNIE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:S
Last Name:COLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9724 KINGSTON PIKE
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3347
Mailing Address - Country:US
Mailing Address - Phone:865-470-2546
Mailing Address - Fax:865-470-2541
Practice Address - Street 1:9724 KINGSTON PIKE
Practice Address - Street 2:SUITE 1004
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3347
Practice Address - Country:US
Practice Address - Phone:865-470-2546
Practice Address - Fax:865-470-2541
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP-1388103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11269OtherVALUE OPTIONS
4084729OtherAETNA
95040OtherBLUE CROSS
4084729OtherAETNA