Provider Demographics
NPI:1881774529
Name:COLE, PAUL R (LCSW)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:COLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HUNTINGTON RD 704
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7215
Mailing Address - Country:US
Mailing Address - Phone:706-552-0706
Mailing Address - Fax:706-552-0756
Practice Address - Street 1:1 HUNTINGTON RD 704
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7215
Practice Address - Country:US
Practice Address - Phone:706-552-0706
Practice Address - Fax:706-552-0756
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0015721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA304122478DMedicaid
GA304122478AMedicaid
GA304122478CMedicaid
GA304122478DMedicaid
GA304122478AMedicaid