Provider Demographics
NPI:1831699693
Name:COLE, LACOLE A (LGPC)
Entity type:Individual
Prefix:MRS
First Name:LACOLE
Middle Name:A
Last Name:COLE
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 MALCOLM RD
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-4029
Mailing Address - Country:US
Mailing Address - Phone:240-346-1974
Mailing Address - Fax:301-263-7894
Practice Address - Street 1:3195 OLD WASHINGTON RD STE 110
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3201
Practice Address - Country:US
Practice Address - Phone:301-494-4020
Practice Address - Fax:240-346-1974
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health