Provider Demographics
NPI:1821396631
Name:COLES, JEAN MARY (LPC; LCMHC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARY
Last Name:COLES
Suffix:
Gender:F
Credentials:LPC; LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3146 LOBELIA LANE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451
Mailing Address - Country:US
Mailing Address - Phone:570-840-0523
Mailing Address - Fax:
Practice Address - Street 1:3146 LOBELIA LANE
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451
Practice Address - Country:US
Practice Address - Phone:570-840-0523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19877101YP2500X
PAPC000246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional