Basic Information
Provider Information
NPI: 1003005604
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COLE
FirstName: CHRISTY
MiddleName: ANN
NamePrefix: MS.
NameSuffix:  
Credential: LCPC, LCMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2 CHRISTENSEN LN
Address2: SUITE 2
City: KENNEBUNK
State: ME
PostalCode: 040437759
CountryCode: US
TelephoneNumber: 2079674929
FaxNumber:  
Practice Location
Address1: 2 CHRISTENSEN LN
Address2: SUITE 2
City: KENNEBUNK
State: ME
PostalCode: 040437759
CountryCode: US
TelephoneNumber: 2079674929
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/18/2007
LastUpdateDate: 10/18/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X590NHN Behavioral Health & Social Service ProvidersCounselorMental Health
101YP2500XCC2671MEY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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