Provider Demographics
NPI:1720220965
Name:COLE, TERRY (LPC, MAC, CCS)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:LPC, MAC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7146 SOUTHLAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3075
Mailing Address - Country:US
Mailing Address - Phone:770-960-9961
Mailing Address - Fax:770-960-9664
Practice Address - Street 1:7146 SOUTHLAKE PKWY
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3075
Practice Address - Country:US
Practice Address - Phone:770-960-9961
Practice Address - Fax:770-960-9664
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA501603101YA0400X
101YP2500X
GALPC002004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)