Healthcare Provider Details

I. General information

NPI: 1730096363
Provider Name (Legal Business Name): GINA MAE COLE MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 S WASHINGTON ST STE 313
MARION IN
46953-1929
US

IV. Provider business mailing address

4227 W DIVISION RD
WABASH IN
46992-8484
US

V. Phone/Fax

Practice location:
  • Phone: 765-233-9495
  • Fax:
Mailing address:
  • Phone: 317-213-1648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33014114A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: