Provider Demographics
NPI:1982049334
Name:COLE, DORIAN TERRANCE
Entity Type:Individual
Prefix:
First Name:DORIAN
Middle Name:TERRANCE
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 W 167TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-5160
Mailing Address - Country:US
Mailing Address - Phone:323-377-0145
Mailing Address - Fax:
Practice Address - Street 1:839 W 167TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-5160
Practice Address - Country:US
Practice Address - Phone:323-377-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor