Provider Demographics
NPI:1508525593
Name:COLE, HEATHER COLLEEN (NBC-HWC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:COLLEEN
Last Name:COLE
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 GLEN ARBOR LOOP
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8881
Mailing Address - Country:US
Mailing Address - Phone:803-445-7733
Mailing Address - Fax:
Practice Address - Street 1:612 SAINT ANDREWS RD STE 2
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5120
Practice Address - Country:US
Practice Address - Phone:803-386-8684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date: