Healthcare Provider Details

I. General information

NPI: 1942021423
Provider Name (Legal Business Name): KAE'VIONNA COLE LCSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 CRITERION DR UNIT 62092
COLORADO SPRINGS CO
80962-1014
US

IV. Provider business mailing address

8585 CRITERION DR UNIT 62092
COLORADO SPRINGS CO
80962-1014
US

V. Phone/Fax

Practice location:
  • Phone: 719-204-6223
  • Fax:
Mailing address:
  • Phone: 719-204-6223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWC.0000000880
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09932875
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: