Provider Demographics
NPI:1922485879
Name:COLE, MICHELLE E (CERT MED TEACHER)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:E
Last Name:COLE
Suffix:
Gender:F
Credentials:CERT MED TEACHER
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:E
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CERT TEACHER MD
Mailing Address - Street 1:5455 SIR DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:BRYANS ROAD
Mailing Address - State:MD
Mailing Address - Zip Code:20616-6020
Mailing Address - Country:US
Mailing Address - Phone:202-445-7204
Mailing Address - Fax:
Practice Address - Street 1:1100 1ST ST SE APT 417
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4709
Practice Address - Country:US
Practice Address - Phone:202-248-0803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6025OtherMD EDUCATOR CERTIFICATION