Basic Information
| Provider Information | |||||||||
| NPI: | 1134765019 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLE | ||||||||
| FirstName: | SETH | ||||||||
| MiddleName: | PETER | ||||||||
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| Credential: | CSAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2771 NC HIGHWAY 14 | ||||||||
| Address2: | |||||||||
| City: | REIDSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273208713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365225095 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2771 NC HIGHWAY 14 | ||||||||
| Address2: | |||||||||
| City: | REIDSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273208713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365225095 | ||||||||
| FaxNumber: | 3364504440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2019 | ||||||||
| LastUpdateDate: | 11/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CSAC-22502 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.