MEDICARE: ALESIA COLE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1612	KY

General Provider Information

NPI Number	:	1790966620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALESIA COLE LCSW

Provider Business Mailing Address
First Line	:	PO BOX 40
Second Line	:
City	:	WHITESBURG
State	:	KY
Zip	:	41858-0040
Country	:	US
Telephone Number	:	606-633-4823
Fax Number	:

Provider Business Practice Location Address
First Line	:	826 KY 11 N
Second Line	:
City	:	BOONEVILLE
State	:	KY
Zip	:	41314-9155
Country	:	US
Telephone Number	:	606-593-6395
Fax Number	:	606-593-5916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	01/31/2017

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Directions to “ ALESIA COLE LCSW” Practice Location

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