Provider Demographics
NPI:1851498554
Name:COLE, JAMISON MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMISON
Middle Name:MARIE
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 1:834 N LANE ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1718
Mailing Address - Country:US
Mailing Address - Phone:907-570-8850
Mailing Address - Fax:907-570-8850
Practice Address - Street 1:834 N LANE ST APT 4
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1747
Practice Address - Country:US
Practice Address - Phone:907-570-8850
Practice Address - Fax:907-570-8850
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK263146000OtherMAGELLAN HEALTH SERVICES