Provider Demographics
NPI:1578526083
Name:COLE, ELAINE M (LCSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:COLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-5200
Mailing Address - Country:US
Mailing Address - Phone:434-572-6916
Mailing Address - Fax:434-572-4881
Practice Address - Street 1:523 MADISON STREET
Practice Address - Street 2:
Practice Address - City:BOYDTON
Practice Address - State:VA
Practice Address - Zip Code:23917
Practice Address - Country:US
Practice Address - Phone:434-738-0154
Practice Address - Fax:434-738-9545
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040019681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1700890761 - GR. NPIMedicaid
VA267381OtherANTHEM, HLTHKPRS (BRUN)
VA518755OtherVALUE OPTIONS
VAO89897OtherSENTARA
VA267382OtherANTHEM, HLTHKPRS (MECK)
VA267379OtherANTHEM, HLTHKPRS (HAL)
VA267381OtherANTHEM, HLTHKPRS (BRUN)