Healthcare Provider Details

I. General information

NPI: 1629615257
Provider Name (Legal Business Name): BROOKLYNN COGGINS COLE MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N SALISBURY ST
LEXINGTON NC
27292-3548
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 336-243-7475
  • Fax: 336-249-6771
Mailing address:
  • Phone: 704-874-1904
  • Fax: 704-864-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP014167
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: