Provider Demographics
NPI:1598160582
Name:COLE, ALANA MARIE (MS TLLP)
Entity Type:Individual
Prefix:MS
First Name:ALANA
Middle Name:MARIE
Last Name:COLE
Suffix:
Gender:F
Credentials:MS TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4648 WALNUT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1407
Mailing Address - Country:US
Mailing Address - Phone:248-770-5042
Mailing Address - Fax:
Practice Address - Street 1:23810 MICHIGAN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1830
Practice Address - Country:US
Practice Address - Phone:586-834-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016146103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent