Provider Demographics
NPI:1710743646
Name:COLE, ANNICK K (RBT)
Entity Type:Individual
Prefix:
First Name:ANNICK
Middle Name:K
Last Name:COLE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15917 BRADICKS CT
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7906
Mailing Address - Country:US
Mailing Address - Phone:352-321-6522
Mailing Address - Fax:
Practice Address - Street 1:15917 BRADICKS CT
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-7906
Practice Address - Country:US
Practice Address - Phone:352-321-6522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-330385106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician