Provider Demographics
NPI:1336390731
Name:COLE, DEANNA (PSYD, MBA)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:PSYD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:PATUXENT RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20670-2846
Mailing Address - Country:US
Mailing Address - Phone:301-200-2045
Mailing Address - Fax:
Practice Address - Street 1:459 CEDAR POINT RD
Practice Address - Street 2:
Practice Address - City:PATUXENT RIVER
Practice Address - State:MD
Practice Address - Zip Code:20670-9998
Practice Address - Country:US
Practice Address - Phone:301-200-2045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MD04966103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist