Provider Demographics
NPI:1447600812
Name:COLE, JASON ROBERT (MA, LPC, CAMS-II)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:COLE
Suffix:
Gender:M
Credentials:MA, LPC, CAMS-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PROFESSIONAL CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7971
Mailing Address - Country:US
Mailing Address - Phone:919-706-5004
Mailing Address - Fax:919-706-5651
Practice Address - Street 1:100 PROFESSIONAL CT
Practice Address - Street 2:SUITE 104
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7971
Practice Address - Country:US
Practice Address - Phone:919-706-5004
Practice Address - Fax:919-706-5651
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC11024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional