MEDICARE: MRS. YVONNE ICILDA 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	CSW002936	GA

General Provider Information

NPI Number	:	1972529824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YVONNE ICILDA COLE LCSW

Provider Business Mailing Address
First Line	:	2819 COBB PLACE MANOR CT
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-3662
Country	:	US
Telephone Number	:	678-640-4656
Fax Number	:	678-581-5560

Provider Business Practice Location Address
First Line	:	6810 ROSWELL RD NE STE 2H
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-2445
Country	:	US
Telephone Number	:	678-640-4656
Fax Number	:

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/09/2007

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