Provider Demographics
NPI:1134261936
Name:COLE, SIMONA MARIE (MS)
Entity type:Individual
Prefix:MS
First Name:SIMONA
Middle Name:MARIE
Last Name:COLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:SIMONA
Other - Middle Name:MARIE
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA, MS
Mailing Address - Street 1:7485 N PALM AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5764
Mailing Address - Country:US
Mailing Address - Phone:559-221-8100
Mailing Address - Fax:
Practice Address - Street 1:7485 N PALM AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5764
Practice Address - Country:US
Practice Address - Phone:559-221-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59606106H00000X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist