Provider Demographics
NPI:1285199240
Name:COLE, MELISSA ANN (EDS, LPC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:COLE
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 NORTHBROOK PL
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08343-9054
Mailing Address - Country:US
Mailing Address - Phone:856-405-1707
Mailing Address - Fax:
Practice Address - Street 1:801 NORTHBROOK PL
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08343-9054
Practice Address - Country:US
Practice Address - Phone:856-405-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00648100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional