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General NPI Number Information
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NPI Number | 1629340617
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Entity Type | Individual
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Provider Name | CAROLYN COLE LCPC, AMFT
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Gender | Female
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 12/06/2014
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Provider Practice Location Address
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Address Line | 111 N WABASH AVE SUITE 1203
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City | CHICAGO
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State | IL
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Zip | 60602-1903
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Country | US
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Telephone | 312-809-7017
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Fax |
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Provider Business Mailing Address
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Address Line | 111 N WABASH AVE SUITE 1203
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City | CHICAGO
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State | IL
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Zip | 60602-1903
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Country | US
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Telephone | 312-809-7017
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 208.000247
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.009186
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License Number State | IL
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