Healthcare Provider Details

I. General information

NPI: 1578526083
Provider Name (Legal Business Name): ELAINE M COLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 MADISON STREET
BOYDTON VA
23917
US

IV. Provider business mailing address

424 HAMILTON BLVD
SOUTH BOSTON VA
24592-5200
US

V. Phone/Fax

Practice location:
  • Phone: 434-738-0154
  • Fax: 434-738-9545
Mailing address:
  • Phone: 434-572-6916
  • Fax: 434-572-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904001968
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: