Provider Demographics
NPI:1942588405
Name:COLE, LONNELL E
Entity Type:Individual
Prefix:
First Name:LONNELL
Middle Name:E
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 INLAND EMPIRE BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4802
Mailing Address - Country:US
Mailing Address - Phone:909-980-6700
Mailing Address - Fax:909-980-6003
Practice Address - Street 1:2930 INLAND EMPIRE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4802
Practice Address - Country:US
Practice Address - Phone:909-980-6700
Practice Address - Fax:909-980-6003
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor