Provider Demographics
NPI:1962637629
Name:COLE, ELISE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:MARIE
Last Name:COLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MISSION RANCH BLVD APT 52
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-5122
Mailing Address - Country:US
Mailing Address - Phone:952-334-2753
Mailing Address - Fax:
Practice Address - Street 1:7629 PURFOY RD STE 117
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-9550
Practice Address - Country:US
Practice Address - Phone:919-285-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49426101YM0800X
NC1787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health