Provider Demographics
NPI:1457981375
Name:COLES, JOAN MICHELLE (MS APC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MICHELLE
Last Name:COLES
Suffix:
Gender:F
Credentials:MS APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 THE OAKS
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-1272
Mailing Address - Country:US
Mailing Address - Phone:678-697-2631
Mailing Address - Fax:
Practice Address - Street 1:4343 SHALLOWFORD RD STE H4B
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5008
Practice Address - Country:US
Practice Address - Phone:678-740-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006716101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional