Provider Demographics
NPI:1356314447
Name:COLE, PAUL CLETUS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:CLETUS
Last Name:COLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 LYNNHAVEN PKWY
Mailing Address - Street 2:S
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7324
Mailing Address - Country:US
Mailing Address - Phone:757-802-4500
Mailing Address - Fax:
Practice Address - Street 1:770 LYNNHAVEN PKWY
Practice Address - Street 2:S
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7324
Practice Address - Country:US
Practice Address - Phone:757-802-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040004341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008900094Medicaid
066756OtherANTHEM PPO
066756OtherANTHEM HEALTH KEEPERS
049385OtherMAGELLAN
083380OtherSENTARA OPTIMA
176106OtherCOM PSYCH
288071OtherMAMSI
10477OtherCIGNA
033142OtherVALUE OPTIONS
132033OtherMANAGED HEALTH NETWORK
35150835OtherMULTIPLAN
P00129368OtherMCARE RAILROAD
VA008900094Medicaid