Provider Demographics
NPI:1134725815
Name:WARNER, COLE YOUNGER (MA)
Entity type:Individual
Prefix:MR
First Name:COLE
Middle Name:YOUNGER
Last Name:WARNER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 QUEENSWAY RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-7373
Mailing Address - Country:US
Mailing Address - Phone:269-270-5559
Mailing Address - Fax:
Practice Address - Street 1:5200 QUEENSWAY RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-7373
Practice Address - Country:US
Practice Address - Phone:269-270-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health