Provider Demographics
NPI:1063221471
Name:COLE, PORSCHIA MCDONALD
Entity type:Individual
Prefix:
First Name:PORSCHIA
Middle Name:MCDONALD
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 CHAMBORD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-4028
Mailing Address - Country:US
Mailing Address - Phone:769-666-1958
Mailing Address - Fax:
Practice Address - Street 1:102 INWOOD PL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9826
Practice Address - Country:US
Practice Address - Phone:769-666-1958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional