Provider Demographics
NPI:1144616442
Name:COLE, ROCKY L (MA)
Entity Type:Individual
Prefix:MR
First Name:ROCKY
Middle Name:L
Last Name:COLE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:KAAAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96730-0010
Mailing Address - Country:US
Mailing Address - Phone:808-304-2650
Mailing Address - Fax:
Practice Address - Street 1:2094 FLAGLER RD
Practice Address - Street 2:RM. 203A
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96857
Practice Address - Country:US
Practice Address - Phone:808-304-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor