Provider Demographics
NPI:1164177382
Name:COLE, PRINCESS C (CAC,CLC,CTP)
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:C
Last Name:COLE
Suffix:
Gender:F
Credentials:CAC,CLC,CTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5376 CINDERLANE PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1026
Mailing Address - Country:US
Mailing Address - Phone:321-444-0554
Mailing Address - Fax:
Practice Address - Street 1:5376 CINDERLANE PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1026
Practice Address - Country:US
Practice Address - Phone:321-444-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)