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General NPI Number Information
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NPI Number | 1164003471
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Entity Type | Individual
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Provider Name | JESSICA FANCHER COLE DSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 113 W LIBERTY ST STE 202
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City | CHARLES TOWN
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State | WV
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Zip | 25414-1548
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Country | US
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Telephone | 304-629-0900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3314
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443-3314
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Country | US
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Telephone | 304-629-0900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | DP00944444
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License Number State | WV
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