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General NPI Number Information
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NPI Number | 1568515435
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Entity Type | Individual
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Provider Name | THERESA GRACE COLE LCSW, ACSW
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 1412 PETERMAN DR SUITE A
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3432
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Country | US
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Telephone | 318-787-6805
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Fax | 318-787-6818
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Provider Business Mailing Address
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Address Line | 5802 CARL ST
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City | ALEXANDRIA
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State | LA
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Zip | 71301-2802
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Country | US
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Telephone | 318-787-2283
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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 | 937
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License Number State | LA
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