Provider Demographics
NPI:1578183513
Name:COLE, KAYE WILLIAMS
Entity Type:Individual
Prefix:DR
First Name:KAYE
Middle Name:WILLIAMS
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10005 STRIKE THE GOLD LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8084
Mailing Address - Country:US
Mailing Address - Phone:803-439-3787
Mailing Address - Fax:
Practice Address - Street 1:10005 STRIKE THE GOLD LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-8084
Practice Address - Country:US
Practice Address - Phone:803-439-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15369101YM0800X
SC214649101YS0200X
NC1230866101YS0200X
IA099825101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool