Provider Demographics
NPI:1871842773
Name:COLE, SOPHIA NATASHA (LCSW)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:NATASHA
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 1:6012 BAYFIELD PKWY STE 223
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7597
Mailing Address - Country:US
Mailing Address - Phone:919-679-2162
Mailing Address - Fax:
Practice Address - Street 1:267 ELM AVE NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4843
Practice Address - Country:US
Practice Address - Phone:919-679-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16201101YA0400X
NCC0090831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC009083OtherLCSW