Provider Demographics
NPI:1972529824
Name:COLE, YVONNE ICILDA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:ICILDA
Last Name:COLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 COBB PLACE MANOR CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3662
Mailing Address - Country:US
Mailing Address - Phone:678-640-4656
Mailing Address - Fax:678-581-5560
Practice Address - Street 1:6810 ROSWELL RD NE STE 2H
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-2445
Practice Address - Country:US
Practice Address - Phone:678-640-4656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0029361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical