Provider Demographics
NPI:1851864201
Name:COLES, TERRILL ANTHONY (LGSW)
Entity Type:Individual
Prefix:
First Name:TERRILL
Middle Name:ANTHONY
Last Name:COLES
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 Q ST NE APT 2413
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2394
Mailing Address - Country:US
Mailing Address - Phone:434-426-7674
Mailing Address - Fax:
Practice Address - Street 1:650 PENNSYLVANIA AVE SE STE 440
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4424
Practice Address - Country:US
Practice Address - Phone:202-544-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50082135104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker