Healthcare Provider Details

I. General information

NPI: 1467054361
Provider Name (Legal Business Name): CHRISTINA MARIE COLE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2020
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MARKET ST STE 119
BOARDMAN OH
44512-2616
US

IV. Provider business mailing address

5500 MARKET ST STE 119
BOARDMAN OH
44512-2616
US

V. Phone/Fax

Practice location:
  • Phone: 330-991-9117
  • Fax:
Mailing address:
  • Phone: 330-991-9117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-144682
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-63369
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: