Provider Demographics
NPI:1710994140
Name:COLE, CAROLYN F (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:F
Last Name:COLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6338
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-0338
Mailing Address - Country:US
Mailing Address - Phone:202-232-1031
Mailing Address - Fax:301-585-6526
Practice Address - Street 1:1616 18TH ST NW
Practice Address - Street 2:SUITE 105
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2530
Practice Address - Country:US
Practice Address - Phone:202-232-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001315103TC0700X
DC1000145103TC0700X
MD02047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC551836Medicare ID - Type Unspecified
MD551836Medicare ID - Type Unspecified
VA551836Medicare ID - Type Unspecified