Provider Demographics
NPI:1770858763
Name:COLE, CHRIS EVAN (MA, LPC)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:EVAN
Last Name:COLE
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20915 ASHBURN RD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5677
Mailing Address - Country:US
Mailing Address - Phone:706-464-0877
Mailing Address - Fax:
Practice Address - Street 1:20915 ASHBURN RD
Practice Address - Street 2:SUITE 235
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5677
Practice Address - Country:US
Practice Address - Phone:706-464-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002188101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional