Provider Demographics
NPI:1407110208
Name:COLE, JOHN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 S MIAMI BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8589
Mailing Address - Country:US
Mailing Address - Phone:919-354-0840
Mailing Address - Fax:
Practice Address - Street 1:6060 PIEDMONT ROW DR S STE 500
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28287-3803
Practice Address - Country:US
Practice Address - Phone:980-326-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0085291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical