Provider Demographics
NPI:1841001955
Name:COLE, SAMANTHA JADE SHOLAR
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JADE SHOLAR
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14072 ELKIN HIGHWAY 268
Mailing Address - Street 2:
Mailing Address - City:RONDA
Mailing Address - State:NC
Mailing Address - Zip Code:28670-9199
Mailing Address - Country:US
Mailing Address - Phone:336-827-0089
Mailing Address - Fax:
Practice Address - Street 1:14072 ELKIN HIGHWAY 268
Practice Address - Street 2:
Practice Address - City:RONDA
Practice Address - State:NC
Practice Address - Zip Code:28670-9199
Practice Address - Country:US
Practice Address - Phone:336-827-0089
Practice Address - Fax:844-676-0500
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20976101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional