Provider Demographics
NPI:1265969224
Name:KOLE, ELIZABETH SAMANTHA (LMSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:SAMANTHA
Last Name:KOLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 HUMPHREY AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-3642
Mailing Address - Country:US
Mailing Address - Phone:248-444-1667
Mailing Address - Fax:
Practice Address - Street 1:6960 ORCHARD LAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4523
Practice Address - Country:US
Practice Address - Phone:248-648-3406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-21
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68011009981041C0700X
MI6801105598104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical