Provider Demographics
NPI:1902120157
Name:COLE, ANNA CAROLINE (MA)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:CAROLINE
Last Name:COLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 MAFFITT CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5906
Mailing Address - Country:US
Mailing Address - Phone:910-263-5475
Mailing Address - Fax:
Practice Address - Street 1:2801 MAFFITT CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5906
Practice Address - Country:US
Practice Address - Phone:910-263-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health