Healthcare Provider Details

I. General information

NPI: 1306458468
Provider Name (Legal Business Name): DOMINIQUE COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 TIGER DR
THIBODAUX LA
70301-4337
US

IV. Provider business mailing address

806 JEFFERSON TER
NEW IBERIA LA
70560-5727
US

V. Phone/Fax

Practice location:
  • Phone: 985-449-4055
  • Fax:
Mailing address:
  • Phone: 337-365-4945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9632
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: