Provider Demographics
NPI:1316693484
Name:COLE, JACQUELYN TEMERDIS (LMSW, CADC, LADAC)
Entity type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:TEMERDIS
Last Name:COLE
Suffix:
Gender:F
Credentials:LMSW, CADC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-3165
Mailing Address - Country:US
Mailing Address - Phone:501-838-0883
Mailing Address - Fax:
Practice Address - Street 1:2900 S SPRING ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-3165
Practice Address - Country:US
Practice Address - Phone:501-838-0883
Practice Address - Fax:682-206-3447
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR416-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty