Provider Demographics
NPI:1154797272
Name:COLE, JUSTIN (LLBSW, CADC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:LLBSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 STILLRIVER DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843
Mailing Address - Country:US
Mailing Address - Phone:517-740-1429
Mailing Address - Fax:
Practice Address - Street 1:3157 STILLRIVER DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-7385
Practice Address - Country:US
Practice Address - Phone:517-740-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020884651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical