Provider Demographics
NPI:1346921889
Name:KOLE, CERENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CERENE
Middle Name:
Last Name:KOLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CERENE
Other - Middle Name:
Other - Last Name:DAHIYAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:74 LONDONDERRY LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4669
Mailing Address - Country:US
Mailing Address - Phone:248-410-4242
Mailing Address - Fax:
Practice Address - Street 1:51 S WASHINGTON ST STE F
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6418
Practice Address - Country:US
Practice Address - Phone:800-693-1916
Practice Address - Fax:248-605-3525
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301019268103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical