Provider Demographics
NPI:1285036657
Name:MCCOLE, JAMIE (MA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MCCOLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 RANCHETTE RD
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-9097
Mailing Address - Country:US
Mailing Address - Phone:908-319-7555
Mailing Address - Fax:
Practice Address - Street 1:204 RANCHETTE RD
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-9097
Practice Address - Country:US
Practice Address - Phone:908-319-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMH12259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health