Provider Demographics
NPI:1942493960
Name:COLE, JUDITH LEGGETT (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:LEGGETT
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 1:403 PRINCETON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2056
Mailing Address - Country:US
Mailing Address - Phone:423-282-2073
Mailing Address - Fax:
Practice Address - Street 1:403 PRINCETON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2056
Practice Address - Country:US
Practice Address - Phone:423-282-2073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNIP4341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN045309OtherBLUE CROSS BLUE SHIELD