Provider Demographics
NPI:1023084589
Name:COLE, SANDRA ANN (LMSW, ACSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:COLE
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2652 SPRING ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3604
Mailing Address - Country:US
Mailing Address - Phone:517-240-5777
Mailing Address - Fax:855-607-6577
Practice Address - Street 1:2652 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3604
Practice Address - Country:US
Practice Address - Phone:517-240-5777
Practice Address - Fax:855-607-6577
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010676091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical