Provider Demographics
NPI:1942559877
Name:COLE, MARTHA MELANIE AMANDA
Entity Type:Individual
Prefix:MISS
First Name:MARTHA
Middle Name:MELANIE AMANDA
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16141 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-3519
Mailing Address - Country:US
Mailing Address - Phone:503-252-3949
Mailing Address - Fax:503-252-4027
Practice Address - Street 1:4710 PLOMONDON ST APT 104
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6188
Practice Address - Country:US
Practice Address - Phone:503-995-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)