Provider Demographics
NPI:1982840534
Name:COLE, MICHELE THERESA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:THERESA
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 1:117 S SAINT ASAPH ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3119
Mailing Address - Country:US
Mailing Address - Phone:571-483-0306
Mailing Address - Fax:571-483-0356
Practice Address - Street 1:117 S SAINT ASAPH ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3119
Practice Address - Country:US
Practice Address - Phone:571-483-0306
Practice Address - Fax:571-483-0356
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040065791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical