Provider Demographics
NPI:1760581433
Name:COLE, DONNA D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:D
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 1:233 OIL WELL RD STE E
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8014
Mailing Address - Country:US
Mailing Address - Phone:731-664-6525
Mailing Address - Fax:731-660-8495
Practice Address - Street 1:233 OIL WELL RD STE E
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-8014
Practice Address - Country:US
Practice Address - Phone:731-664-6525
Practice Address - Fax:731-660-8495
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7412330OtherAETNA
TN4031806OtherBCBS
TN278233000OtherMAGELLAN
TN3698526Medicaid
TN3698526Medicare ID - Type Unspecified
TN800013161Medicare ID - Type UnspecifiedRR MEDICARE