MEDICARE: JULIE S COLE LAC

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	104100000X	Social Worker	8452	SC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	193	SC

General Provider Information

NPI Number	:	1992264493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE S COLE LAC

Provider Business Mailing Address
First Line	:	3543 DREHER SHOALS RD STE 2
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-7608
Country	:	US
Telephone Number	:	803-630-1402
Fax Number	:

Provider Business Practice Location Address
First Line	:	3543 DREHER SHOALS RD STE 2
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-7608
Country	:	US
Telephone Number	:	803-630-1402
Fax Number	:

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

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	03/14/2019

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Directions to “ JULIE S COLE LAC” Practice Location

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